HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Robert C. Vannucci

doi:10.1055/s-2000-9293

American Journal of Perinatology, Table of Contents

Am J Perinatol 2000; Volume 17(Number 03): 113-120
DOI: 10.1055/s-2000-9293

HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Robert C. Vannucci

Department of Pediatric Neurology, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey Pennsylvania

Abstract

ABSTRACT

Cerebral hypoxia-ischemia (asphyxia) occurring in the fetus and newborn infant is a major cause of acute mortality and chronic neurological disability in survivors. This review highlights many practical aspects of perinatal hypoxic-ischemic brain damage, including neuropathological features, obstetrical antecedents, and clinically important aspects of identification, management, and prognosis. Diagnostic techniques, including neuro-imaging, to diagnose hypoxic-ischemic encephalopathy also are discussed. A thorough knowledge of the clinical spectrum of perinatal hypoxic-ischemic encephalopathy should enable neonatologists to undertake appropriate management strategies and prognostic indicators.

KEYWORD

Asphyxia - brain - fetus - hypoxia-ischemia - perinatal

Full Text

References

REFERENCES

1 Little W J. On the influence of abnormal parturition, difficult labors, premature birth and asphyxia neonatorum on the mental and physical condition of the child, especially in relation to deformities. Lancet . 1861; 2 378-381
2 MacDonald H M, Mulligan J G, Allen A C, Taylor P M. Neonatal asphyxia. I. Relationship to obstetrical and neonatal complications to neonatal mortality in 38,405 consecutive deliveries. J Pediatr . 1980; 96 898-902
3 Perelman R H, Farrell P M. Analysis of causes of neonatal death in the United States with specific emphasis on fetal hyaline membrane disease. Pediatrics . 1982; 70 570-575
4 Low J A, Lindsay B G, Derrick E J. Threshold of metabolic acidosis associated with newborn complications. Am J Obstet Gynecol . 1997; 177 1391-1394
5 Vannucci R C, Palmer C. Hypoxic-ischemic encephalopathy. In: Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine IV Philadelphia: Mosby-Yearbook, Inc 1997: 856-877
6 Sarnat H B, Sarnat M S. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol . 1976; 33 695-706
7 Ekert P, Perlman M, Steinlin M, Hao Y. Predicting the outcome of postasphyxial hypoxic-ischemic encephalopathy within 4 hours of birth. J Pediatr . 1997; 131 613-617
8 Volpe J J. Neurology of the Newborn III. Philadelphia: W.B. Saunders; 1997
9 Flodmark O, Becker L E, Harwood-Nash D C, Fitzhardinge P M, Fitz C R, Chuang S H. Correlation between computed tomography and autopsy in premature and full-term neonates that have suffered perinatal asphyxia. Neuroradiology . 1980; 137 93-103
10 Schrumpf J D, Sehring S, Killpack S, Brady J P, Kirata T, Mednick J P. Correlation of early neurologic outcome and CT findings in neonatal brain hypoxia and injury. J Comput Assist Tomogr . 1980; 4 445-450
11 Graziani L J, Pasto M, Stanley C. Neonatal neurosonographic correlates of cerebral palsy in preterm infants. Pediatrics . 1986; 78 88-95
12 Pidcock F S, Graziani L J, Stanley C, Mitchell D G, Merton D. Neurosonographic features of periventricular echodensities associated with cerebral palsy in preterm infants. J Pediatr . 1990; 116 417-422
13 Barkovich A J, Truwit C L. Brain damage from perinatal asphyxia: correlation of MR findings with gestational age. Am J Neuroradiol . 1990; 11 1087-1096
14 Steinlin M, Dirr R, Martin E. MRI following severe perinatal asphyxia: preliminary experience. Pediatr Neurol . 1991; 7 164-170
15 Clancy R, Legido A, Newell R, Bruce D, Baumegart S, Fox W W. Continuous intracranial pressure monitoring and serial electroencephalographic recordings in severely asphyxiated term neonates. Am J Dis Child . 1988; 142 740-747
16 Scher M S, Painter M J, Bergman I, Barmada M A, Blunberg J. EEG prognoses of neonatal seizures: clinical correlations and outcome. Pediatr Neurol . 1989; 5 17-24
17 Vannucci R C, Perlman J M. Interventions for perinatal hypoxic-ischemic encephalopathy. Pediatrics . 1997; 100 1004-1014
18 Hall R T, Hall F K, Daily D K. High-dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: a randomized, prospective study with three-year follow-up. J Pediatr . 1998; 132 345-348
19 Gunn A J, Gunn T R, De Haan H H, Williams C E, Gluckman P D. Dramatic neuronal rescue with prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest . 1997; 99 248-256
20 Gunn A J, Gunn T R, Gunning M I, Williams C E, Gluckman P D. Neuroprotection with prolonged head cooling started before postischemic seizures in fetal sheep. Pediatrics . 1998; 102 1098-1106
21 Gunn A J, Bennet L, Gunning M I, Gluckman P D, Gunn T R. Cerebral hypothermia is not neuroprotective when started after post-ischemic seizures in fetal sheep. Pediatr Res . 1999; 46 274-280
22 Gunn A J, Gluckman P D, Gunn T R. Selective head cooling in newborn infants after perinatal asphyxia: a safety study. Pediatrics . 1998; 102 885-892
23 Painter M J, Depp R, O'Donoghue P D. Fetal heart rate patterns and development in the first year of life. Am J Obstet Gynecol . 1978; 132 271-277
24 Low J A, Galbraith R S, Muer D W, Killen H L, Pater E A, Karchmar E J. Factors associated with motor and cognitive deficits in children after intrapartum fetal hypoxia. Am J Obstet Gynecol . 1984; 148 533-539
25 Painter M J, Scott M, Hirsch R P, O'Donoghue P, Depp R. Fetal heart rate patterns during labor: neurologic and cognitive development at six to nine years of age. Am J Obstet Gynecol . 1988; 159 854-858
26 Nelson K B, Dambrosia J M, Ting T Y, Grether J K. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med . 1996; 334 613-618
27 Manning F A, Bondaji N, Harman C R. Fetal assessment based on fetal biophysical profile scoring. Am J Obstet Gynecol . 1998; 178 696-706
28 Manning F A, Snijders S, Harman C R, Nicolaides K, Menticogolu S, Morrison I. Fetal biophysical profile VI: correlation with antipartum umbilical venous fetal pH. Am J Obstet Gynecol . 1993; 169 755-763
29 Goldaber K G, Gilstrap L C, Leveno K J, Dax J S, McIntire D D. Pathologic fetal acidemia. Obstet Gynecol . 1991; 78 1103-1107
30 Low J A, Panagiotopoulos C, Derrick E J. Newborn complications after intrapartum asphyxia with metabolic acidosis in the term fetus. Am J Obstet Gynecol . 1994; 170 1081-1087
31 Finer N N, Robertson C M, Richards R T, Pinnell L E, Petters K L. Hypoxic-ischemic encephalopathy in term neonates: perinatal factors and outcome. J Pediatr . 1981; 98 112-117
32 Robertson C MT, Finer N N, Grace M GA. School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term. J Pediatr . 1989; 114 753-760
33 Lipper E G, Voorhies T M, Ross G, Vannucci R C, Auld P AM. Early predictors of 1-year outcome for infants asphyxiated at birth. Dev Med Child Neurol . 1986; 28 303-309