Contents Chapter Topic Page Neonatology Respiratory Cardiology

Staging of Neonatal /Hypoxic Ischaemic Encephalopathy (HIE)
MILD (Stage I)
subtle abnormality
days
Irritable with exaggerated
and frequent Moro’s.
Hyperalert (look of
hunger, wide eye gaze,
failure to fixate.
Normal tone
Weak suck ( NG)
Sympathetic dominance
with tachycardia and
mydriasis.
No seizure clinically
No Impairment
Important to note:
Only constant in term infants or > 35 weeks. Not consistent in Prems.
MODERATE
ENCEPHALOPATHY
(Stage II)
Lethargy with
spontaneous movement
Moro’s and other
primitive reflexes lost in
early stages, tendon jerks
exaggerated.
Differential tone with
LL>UL and neck
extensors>flexors
Seizures ++ (lip
smacking, sucking, tonic
or clonic seizures.)
Poor suck (NG required)
Parasympathetic
dominance with
bradycardia and
constricted pupils.
25% Impaired
SEVERE
ENCEPHALOPATHY
(Stage III)
Comatose with little
spontaneous movement
Seizures prolonged and
frequent. In very severely
asphyxiated babies no
seizures clinically or EEG
due to completely
exhausted brain energy)
Severely hypotonic
initially with lost of
reflexes
Death
If recovers there is
excessive hypertonia.
Persistent abnormal
neurological signs beyond
6 weeks means CP.
92% Impaired .
i) Absence of encephalopathy does not mean infant has not suffered significant intrapartum
asphyxia (kidney and heart may be affected).
ii) Encephalopathy can be caused by hypoglycaemia or cerebral haemorrhage and therefore have
to be excluded before diagnosing HIE.
D. Complications of Birth Asphyxia
Brain: Periventricular haemorrhage and periventricular leukomalacia. Intracranial
haemorrhage (subdural (5%), subarachnoid (some), choroid plexus, cerebellum
and thalamus). Cerebral oedema occurs after 24-28 hours.
Kidney: Acute tubular necrosis; oliguria; usually recovers with supportive Rx. Rule
out acute urinary retention.
Heart: Hypoxic ischaemic damage (cardiogenic shock, hypotension, heart failure
with atrioventricular valve regurgitation, arrhythmia).
Lungs: Meconium aspiration common
GIT:stress gastric ulcer, feed intolerance and NEC
Metabolic: SIADH (secondary to head injury) , hypoglycaemia, hypocalcaemia,
hypomagnesaemia
Haematological : DIVC