Neonatal Hypoxic Ischemic Encephalopathy - Symptoms, Diagnosis, and Treatment

What Is Meant by Neonatal Hypoxic Ischemic Encephalopathy?

Neonatal hypoxic-ischemic encephalopathy is a brain dysfunction or damage caused by decreased oxygen or blood supply to the brain before or immediately after the baby's birth. The resultant brain damage causes developmental or neurological problems for the baby. It may develop during pregnancy, labor, delivery, or postnatally. ‘Hypoxic’ means ‘lack of oxygen,’ ‘ischemic’ means ‘decreased blood flow,’ and ‘encephalopathy’ indicates brain disorder. The symptoms range may be mild, moderate, or severe. Severe symptoms may lead to permanent disabilities. Neonatal hypoxic-ischemic encephalopathy is also called asphyxia, neonatal encephalopathy, or perinatal asphyxia.

What Are the Risk Factors of Neonatal Hypoxic Ischemic Encephalopathy?

Many factors can lead to neonatal hypoxic-ischemic encephalopathy, some of which may reside with the pregnant mother, and others may be solely associated with the developing child. Some of the risk factors are the following:

1. Cardiac conditions in the baby.

2. Impaired blood flow to the placenta.

3. Severe blood pressure variations in the mother.

4. Disorders associated with the mother’s uterus.

5. Umbilical cord injury.

6. Complications during delivery.

7. Ceaserean or C-section injuries.

8. Impaired blood or oxygen supply to the fetus’s brain within the uterus.

9. Inadequate blood flow to the baby’s brain during birth.

10. Preeclampsia or toxemia is a dangerous complication associated with increased blood pressure during pregnancy.

11. Diabetes in the pregnant mother leads to vascular complications.

12. Trauma to the brain or skull of the baby.

13. When the pregnant mother uses drugs, alcohol, chemicals, or tobacco, the chemicals affect the fetus in the uterus causing impaired growth and development. This is known as maternal substance abuse.

14. Fetal infections.

15. Fetal anemia is when the red blood cell count decreases in the fetal blood.

16. Fetal lung conditions.

17. Uterine rupture.

18. Severe blood loss from the placenta.

19. If the baby experiences cardiac arrest during or immediately after delivery.

20. The breech baby position is when the bottom or feet of the baby are positioned first in the uterus.

21. Low blood pressure in the baby.

22. Respiratory failure of the baby during or immediately after delivery.

23. Preterm delivery of the baby is when birth happens before completing 37 weeks of gestation or pregnancy.

24. A blockage in the blood supply to the fetal brain leads to fetal stroke. It is also called a brain infarct or cerebrovascular accident.

What Are the Signs and Symptoms of Neonatal Hypoxic Ischemic Encephalopathy?

The signs and symptoms of neonatal hypoxic-ischemic encephalopathy depend on the severity of the developed brain injury. Some of them are as follows:

• Breathing difficulties.

• The baby will lack the energy to wake up and cry or be abnormally and highly alert.

• Impaired hearing.

• Reflex problems due to impaired muscle development.

• Seizures (sudden jerking movement due to uncontrolled electrical activity within the brain) or abnormal movements.

• A decreased heart rate.

• Impaired muscle tone.

• Altered consciousness levels.

• Weak muscle development, especially around the mouth and face, may affect feeding.

• Heart, kidney, lung, blood, and liver dysfunction.

• Severe neonatal hypoxic-ischemic encephalopathy impairs the overall growth and development of the baby.

• Cerebral palsy (a motor disability consisting of a group of disorders that impairs muscle tone, movement, and posture).

What Are the Complications of Neonatal Hypoxic Ischemic Encephalopathy?

The complications of neonatal hypoxic-ischemic encephalopathy vary from one child to another. Some of them are listed below:

• Learning and memory difficulties.

• Attention deficit hyperactivity disorder or ADHD (a chronic condition characterized by impulsiveness and hyperactivity).

• Cerebral palsy.

• Seizure disorder or epilepsy.

How to Diagnose Neonatal Hypoxic Ischemic Encephalopathy?

If the symptoms are developed and apparent at the time and immediately after the birth, the doctors can confirm that the baby has neonatal hypoxic-ischemic encephalopathy. In some cases, the symptoms will be evident in the form of seizures, breathing difficulties, decreased heart rate, or abnormal movements during birth. Sometimes, the symptoms will be mild, and the child will only develop them later in life. One or more of the following tests will help diagnose the condition:

• Blood Tests: The blood tests are preliminarily conducted to detect the oxygen level. In addition, enzyme, electrolyte, and nutrient levels will also be determined with the help of blood tests to diagnose neonatal hypoxic-ischemic encephalopathy.

• Electroencephalogram: Electroencephalogram or EEG is a test that detects abnormal waves or electrical activities within the brain. It helps detect the chances of seizures and will be done on the first day after birth.

• Umbilical Cord or Placenta Tests: Umbilical cord or placenta testing helps detect any damages in these areas that could lead to neonatal hypoxic-ischemic encephalopathy.

• Ultrasound: An ultrasound scanning of the head helps detect bleeding or fluid accumulation in the brain that could lead to neonatal hypoxic-ischemic encephalopathy.

• Magnetic Resonance Imaging: MRI or magnetic resonance imaging of the head will be done between four to seven days of age and will help detect any brain damage that can lead to hypoxic-ischemic encephalopathy.

• Lumbar Puncture: Lumbar puncture or spinal tap is a medical technique in which a needle is inserted into the space between the lumbar bones to collect CSF or cerebrospinal fluid. The CSF will be used for further testing to detect any conditions associated with the brain or the spinal cord.

How to Treat Neonatal Hypoxic Ischemic Encephalopathy?

If diagnosed with neonatal hypoxic-ischemic encephalopathy, the following treatments will be provided to the newborn.

Therapeutic Hypothermia: Therapeutic hypothermia or brain cooling is a procedure by which the baby’s body and brain are cooled below average temperature. A cooling system is used to lower the temperature. The treatment will be provided within the first six hours after birth. Brain cooling improves the survival chances and decreases the risk of disabilities or developmental conditions of the baby. The baby will be warmed after the cooling session.

In addition, a combination of treatments will be provided to the baby to support the organ's functioning. It includes the following:

• Mechanical ventilation to support breathing.

• Maintenance of blood pressure to normal.

• Supporting cardiac, renal, and liver function.

• Management of seizures with medications.

Conclusion

Neonatal hypoxic-ischemic encephalopathy is brain damage due to decreased oxygen supply or blood flow to the brain. It may lead to neurological or developmental complications in the baby. The signs and symptoms may be mild, moderate or severe. Mild symptoms may be sometimes shown later in the life of the child.