Introduction:
Hypoxic ischemic encephalopathy is a kind of newborn brain damage where the brain of the offspring does not get enough oxygen or blood supply for some time. Here, hypoxia means less oxygen, ischemia means decreased blood flow, and encephalopathy means a brain disorder. Hypoxic ischemic encephalopathy can also be called a type of birth injury. Birth asphyxia, perinatal asphyxia, and neonatal encephalopathy are stated as other names for hypoxic-ischemic encephalopathy. This situation may develop during the gestational period, labor, or at the time of delivery. It may also develop during the postnatal period. In this kind of dysfunction, some children face only mild to moderate effects, while in other cases, the damage could be severe and lead to permanent damage like disability, delayed growth and development, motor impairment, epilepsy, etc. If the blood or the oxygen supply is stunted, then the rest of the body's organs may also suffer because of a lack of oxygen and blood. These affected organs may return to their normal function, but the injury caused to the brain may not be recovered totally. The time period the brain was deficient in oxygen turns out to be the deciding factor in the level of damage caused.
What Is Hypoxic Ischemic Encephalopathy?
It is a type of dysfunction of the brain of the newborn caused by interrupted oxygen supply and blood flow. It is considered as a serious birth complication affecting the newborn babies. Most of the infants affected by hypoxic-ischemic encephalopathy may die in the initial two years of their lives or may suffer from permanent disabilities. An injury to the brain is caused by two steps: primary energy failure and secondary energy failure. Many people also refer to it by other names, like perinatal asphyxia, birth asphyxia, and encephalopathy.
What Are the Causes of Hypoxic Ischemic Encephalopathy?
Hypoxic ischemic encephalopathy may be caused by various complications at the time of delivery. Sometimes, the physician's neglect could also be the reason behind this type of dysfunction.
During Pregnancy:
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Placental blood flow is sometimes troubled, resulting in decreased or diminished blood and oxygen flow.
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The state of hypertension and the associated problems with it is called preeclampsia. It can also be the cause of hypoxic-ischemic encephalopathy.
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Cardiovascular diseases or disorders.
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Difficulty in the formation of the respiratory system.
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Congenital infections.
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Congenital defects or anomalies.
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Mother with diabetes.
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Anemia or low blood count.
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Parent’s drug addiction.
During the Labor and Delivery Period:
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Placental bleeding.
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Parent’s state of hypotension.
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Problems related to the umbilical cord.
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Uterus rupture.
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When the labor is prolonged.
Postnatal Period:
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Severe respiratory or cardiovascular diseases.
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Severe infection.
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.Hypotension in the baby.
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Failure of the respiratory and cardiac systems.
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When the offspring suffers any trauma, especially to the head.
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When there is premature delivery of the baby.
What Are the Signs and Symptoms of Hypoxic Ischemic Encephalopathy?
Following mentioned are the signs and symptoms of hypoxic-ischemic encephalopathy:
1. Mild Signs and Symptoms of Hypoxic-Ischemic Encephalopathy:
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Brisk deep tendon reflexes and minor increased muscle tone can be observed in the initial few days.
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Short-term or brief abnormalities in the offspring's behavior, such as excessive crying, not feeding properly, excessive sleepiness, or irritability, can be seen too.
2. Moderate Level of Hypoxic-Ischemic Encephalopathy:
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Lethargic behavior, evident hypotonia, and declined deep tendon reflexes.
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Absent reflexes like Moro, grasping, and sucking could be absent or may not be properly functioning. (Moro reflex: It is a reflex where an involuntary protective motor response against sudden loss of body balance or any extreme sudden stimulation).
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Occasional apnea can be observed in the infant.
3. Severe or Serious Level of Hypoxic-Ischemic Encephalopathy:
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Generalized seizures can be seen in such infants.
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Coma and stupor can usually be observed. The infant may not react to vigorous or any other kind of physical stimulation. (Stupor: It is the state of unresponsiveness from which a person can only be aroused by vigorous, strong physical stimulation).
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Irregular breathing.
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Need for ventilator support.
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Declined deep tendon reflex and hypotonia, which is generalized, can be seen commonly.
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Absence of normal neonatal reflexes.
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By cranial nerve examination, disturbed ocular motion or activities can be seen.
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Poorly reactive pupils to the light, also pupils can be dilated or even fixed.
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This stage can be fatal for the infant.
How Is Hypoxic Ischemic Encephalopathy Diagnosed?
When risk factors such as fetal distress or lowered heart rate can be present at the time of labor or the process of parturition, then it can be suspected that the condition of hypoxic-ischemic encephalopathy has happened. When the physician suspects brain dysfunction like hypoxic-ischemic encephalopathy, diagnostic techniques like magnetic resonance imaging (MRI) are used to support and confirm the diagnosis. A few recent techniques that include diffusion-weighted imaging or MR spectroscopy can also be used in an appropriate time period. A neurosurgeon may also examine the offspring by observing its movements or via electroencephalogram. There can be some signs that occur right after birth, such as a dysfunction of organs like the heart, lungs, liver, etc., which predicts the presence of the condition. A seizure can be the most significant sign for the diagnosis of the dysfunction. Laboratory tests like serum electrolyte levels, renal function tests, cardiac and liver enzymes, coagulation tests, and monitoring arterial blood gas are also done.
How Is Hypoxic Ischemic Encephalopathy Treated?
After confirming the diagnosis, therapeutic hypothermia (brain cooling system) can be used as a treatment for hypoxic-ischemic encephalopathy. It almost goes on for three days. The lower temperature than the normal temperature of the brain may cause no or less injury. It is considered as a safe kind of treatment. It is stated that the newborn should have completed 36 weeks or more of pregnancy term. Sometimes, newborns younger than the stated age can still be treated with this treatment. Deciding factors may include various conditions. The diagnosis should be confirmed, and the presence of hypoxia in the brain can be primarily observed to apply this treatment.
Conclusion:
The prognosis of hypoxic-ischemic encephalopathy varies from case to case, depending on the severity of the condition. The brain cooling technique can improve the chance of survival of the newborn and give the child a disability-free life. The newborns may also face physical and intellectual ailments. As it is one of the most serious birth complications, more treatments and therapies should be researched.
