Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neonate > Hypoxic Ischemic Encephalopathy > Flashcards

Hypoxic Ischemic Encephalopathy Flashcards

1
Q

What is hypoxic-ischaemic encephalopathy (HIE)?

A

Hypoxic-ischaemic encephalopathy (HIE) is neonatal encephalopathy (NE) that occurs in the first two days of life and is caused by intrapartum hypoxia and cerebral ischemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is neonatal encephalopathy (NE) characterized?

A

Neonatal encephalopathy is characterized by an abnormal level of consciousness, abnormal tone, and abnormal primitive reflexes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some common manifestations of neonatal encephalopathy (NE)?

A

Seizures and feeding difficulties commonly occur in moderately or severely affected infants with neonatal encephalopathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Besides intrapartum hypoxia, what are some other causes of neonatal encephalopathy (NE)?

A

Other causes of neonatal encephalopathy include
-hypoglycemia,
-electrolyte disturbances,
-sepsis,
-drug effects,
-haemodynamic disturbances,
-brain malformations,
-inborn errors of metabolism, and
-neonatal epileptic syndromes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How common are the causes of neonatal encephalopathy (NE) compared to intrapartum hypoxia?

A

While intrapartum hypoxia is the most common cause of neonatal encephalopathy, the other mentioned causes are less common but must be considered during the assessment of NE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What physiological changes occur during intrapartum fetal hypoxia?

A

Initially, there is fetal bradycardia, and blood flow is shunted towards the brain. However, this shunting compromises the perfusion of other organs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens if hypoxia continues during intrapartum fetal hypoxia?

A

If hypoxia continues, the myocardium becomes critically hypoxic, leading to a decrease in cardiac output and subsequent cerebral ischemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which areas of the brain are most affected by cerebral ischemia during intrapartum fetal hypoxia?

A

In term infants, the basal ganglia (due to their high metabolic rate) and subcortical white matter (due to being in the “water-shed” zone) are most affected by cerebral ischemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the expected neurological outcomes in cases of moderate and severe intrapartum fetal hypoxia?

A

In some cases of moderate and most cases of severe intrapartum fetal hypoxia, spastic quadriplegic or dyskinetic cerebral palsy is the expected neurological outcome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is it important to diagnose hypoxic-ischaemic encephalopathy (HIE) promptly?

A

It is crucial to diagnose HIE promptly so that appropriate supportive care can be provided and interventions such as therapeutic hypothermia can be considered for moderately or severely affected infants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the time frame for initiating therapeutic hypothermia in infants with HIE?

A

Therapeutic hypothermia must be started within 6 hours of life in infants with hypoxic-ischaemic encephalopathy (HIE).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The following findings suggest that the intrapartum hypoxia and ischaemia were of
sufficient severity to potentially cause brain damage:

A
  • Metabolic acidosis with base deficit ≥ 10mmol/l in umbilical arterial blood or the
    infant’s arterial blood within the first hour of life or the ongoing need for assisted
    ventilation 10 minutes after birth.
  • Intrapartum signs or events suggesting fetal compromise or Arterial Cord pH < 7.0.
  • Severe or moderate encephalopathy during the first 48 hours of life.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do the clinical signs in infants with hypoxic-ischaemic encephalopathy (HIE) typically evolve over time?

A

The clinical signs in infants with moderate or severe HIE typically become increasingly obvious or severe during the first 48 to 72 hours of life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are common manifestations of seizures in infants with HIE?

A

eizures in infants with HIE are often clinically silent, but they may also present as rhythmic clonic movements. More frequently, seizures manifest as subtle signs including buccal-lingual movements, abnormal eye movements, cycling movements of limbs, abnormal tonic posturing, or grimacing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can cycling, posturing, and myoclonus in infants with HIE be differentiated from seizures?

A

Cycling, posturing, and myoclonus may alternatively represent a lack of inhibition/control at a brainstem level. EEG confirmation is required to distinguish the etiology of these movements from seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stage 1 of encephalopathy

A

Irritability, increased tone, poor sucking but an exaggerated moro reflex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stage 2 of encephalopathy

A

Lethargy, decreased tone and primitive reflexes. Seizures are common.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Stage 3 of encephalopathy

A

Stupor or Coma, flaccid tone and seizures often clinically less apparent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why is EEG confirmation necessary in infants with hypoxic-ischaemic encephalopathy (HIE)?

A

EEG confirmation is required to distinguish the etiology of certain clinical signs, such as cycling, posturing, and myoclonus, from seizures in infants with HIE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does progression through the stages of hypoxic-ischaemic encephalopathy (HIE) represent?

A

Progression through the stages of HIE represents continuing damage occurring after birth due to reperfusion injury and oxidant damage caused by an excitotoxic cascade at a cellular level.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why might some infants not manifest a typical progression through the stages of HIE?

A

Some infants are born with established damage and may not exhibit a typical progression through the stages of HIE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How might the severity and prognosis of HIE be more reliably assessed?

A

The severity and prognosis of HIE may be more reliably assessed using a detailed HIE score known as the Thompson HIE Score, as there is much overlap between the signs within the stages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is aEEG and what is its significance in cerebral function monitoring?

A

aEEG is a time-compressed, processed EEG used for diagnosing subclinical seizures and providing prognostic value in cerebral function monitoring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does aEEG compare to clinical examination in assessing cerebral function?

A

aEEG is more objective than clinical examination, making it valuable for diagnosing subclinical seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When should aEEG be applied in cerebral function monitoring?

A

aEEG should be applied as soon as possible where available for optimal diagnosis and prognosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can cranial ultrasound reveal in cerebral function monitoring?

A

Cranial ultrasound may show established damage at birth such as oedema, infarction, ischemia, or hemorrhage, as well as evolving focal or global injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the primary aim of assessing and managing infants with HIE?

A

The primary aim is to minimize further organ damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What key aspects should be documented in the assessment of infants with HIE?

A

Document antenatal history, intrapartum events, and management at delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why is medicolegal investigation becoming more common in cases of HIE?

A

Medicolegal investigation is increasing due to the need for accountability and understanding the circumstances surrounding HIE cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does documenting intrapartum events help in managing infants with HIE?

A

Documenting intrapartum events assists in understanding potential causes and guiding appropriate management strategies for infants with HIE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What precautions should be taken during resuscitation at birth for infants with HIE?

A

Avoid over-heating and hyperoxia during resuscitation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When should an arterial blood gas be obtained for infants at birth?

A

An arterial blood gas should be obtained from the umbilical cord or from the infant within the first hour of life.

33
Q

How often should the Apgar score be recorded for infants at birth?

A

The Apgar score should be recorded at 1, 5, and 10 minutes after birth.

34
Q

Where should infants with HIE be admitted after birth?

A

Infants with HIE should be admitted to a high or intensive care area for specialized monitoring and management.

35
Q

What complications can hypoxia cause in the respiratory system?

A

Hypoxia can lead to secondary surfactant deficiency and respiratory failure.

36
Q

How should oxygen saturation and blood gases be monitored in infants with HIE?

A

Monitor oxygen saturation and blood gases regularly to ensure they remain within the normal range.

37
Q

What should be the target range for CO2 and PaO2 levels in infants with HIE?

A

Aim to keep CO2 and PaO2 levels in the normal range.

38
Q

What cardiovascular complications can occur in infants with HIE?

A

Hypoxic damage to the heart,
autonomic instability, and
anaemia may be present.

39
Q

What actions should be taken if hemoglobin levels are below 10g/dl in infants with HIE?

A

Investigate the cause and consider blood transfusion if hemoglobin levels are below 10g/dl.

40
Q

How should blood pressure be managed in infants with HIE?

A

Monitor blood pressure and keep it within the normal range.

41
Q

When should fluid boluses be administered to infants with HIE?

A

Avoid multiple fluid boluses unless the infant is obviously hypovolemic, and consider inotropic support if needed.

42
Q

What are common complications related to fluid balance and electrolytes in infants with HIE?

A

Intrinsic renal failure,
SIADH, and
cerebral edema commonly occur.

43
Q

What is the initial fluid restriction recommendation for infants with HIE?

A

Initially, restrict fluids to 40 ml/kg/24 hours with potassium-free Neonatalyte.

44
Q

What parameters should be monitored regarding fluid balance and electrolytes in infants with HIE?

A

Monitor urine output,
electrolytes,
blood glucose, and
blood gases.

45
Q

What should be done if hypoglycemia occurs in infants with HIE?

A

If hypoglycemia occurs, use 12 or 15% glucose as an infusion solution.

46
Q

What complications should be anticipated and treated regarding calcium and magnesium levels in infants with HIE?

A

Anticipate and treat hypocalcemia and hypomagnesemia.

47
Q

How can multi-organ failure manifest in infants with HIE?

A

Almost all organs can be affected, with manifestations such as thrombocytopenia from bone marrow failure and coagulopathy, hypoglycemia, and hypoalbuminemia from hepatic failure.

48
Q

How does intestinal ischemia affect the management of feeds in infants with HIE?

A

Intestinal ischemia increases the risk of necrotizing enterocolitis, so feeds should be introduced slowly over the first few days, preferably with breastmilk.

49
Q

How is chorioamnionitis related to sepsis in newborns?

A

Chorioamnionitis is associated with intrapartum hypoxia and can lead to sepsis, making it difficult to distinguish from encephalopathy.

50
Q

How should sepsis be managed in newborns with suspected intrapartum hypoxia?

A

Screen for sepsis and treat empirically with antibiotics until investigations exclude sepsis. If indicated by history and investigations, perform a lumbar puncture.

51
Q

What is the importance of temperature control in newborns with encephalopathy?

A

It’s crucial to avoid overheating in newborns with encephalopathy.

52
Q

When is induced hypothermia considered for newborns with moderate or severe encephalopathy?

A

If moderate or severe encephalopathy and evidence of intrapartum hypoxia are present, induced hypothermia may improve outcomes if initiated in term or near-term newborns as soon as possible after birth and no later than 6 hours.

53
Q

What should be done if cooling therapy is considered for a newborn?

A

Cooling therapy should be discussed with a cooling center if available.

54
Q

What should be explained to parents regarding the clinical condition of their infant?

A

Explain the clinical condition of the infant without assigning a final cause to the encephalopathy if there is any doubt.

55
Q

What information should be provided regarding management and investigations?

A

Explain the management needed and the type of investigations that will be done to further understand the condition.

56
Q

How should parents be prepared regarding potential outcomes?

A

Prepare them for a potential poor outcome if investigations and signs are suggestive, while also emphasizing that definitive conclusions may not be immediate.

57
Q

What should parents be informed about regarding prognosis and follow-up?

A

Explain that early neurological examination, aEEG, and MRI can predict outcome, but they are only reliable when abnormalities are severe.

58
Q

What is the prognosis for infants with mild HIE?

A

Infants who remain at Sarnat stage 1 and are neurologically normal within 7 days usually do not develop cerebral palsy.

59
Q

What are the typical characteristics of infants with mild HIE?

A

These infants typically have a peak Thompson score of < 7 in the first six hours of life and a normal CFM.

60
Q

Why is therapeutic hypothermia not usually offered to infants with mild HIE?

A

There is no evidence of benefit from therapeutic hypothermia in this group of infants.

61
Q

What are the outcomes for non-cooled infants with moderate and severe HIE?

A

Without therapeutic hypothermia, 25-40% of infants progressing to Sarnat stage 2 develop cerebral palsy, and around 90% of those progressing to stage 3 either die or develop severe cerebral palsy.

62
Q

What predictive value does the Thompson score hold for non-cooled infants with HIE?

A

A peak Thompson score of < 10 during the first 6 days with a score of 0 by day 7 predicts a normal outcome in the majority. A peak Thompson score of 11–15 at any time or a score above 0 on day 7 predicts an abnormal outcome in 65%. A Thompson score above 15 at any time after 1 hour of life predicts an abnormal outcome.

63
Q

What is the effectiveness of therapeutic hypothermia in cooled infants with moderate or severe HIE?

A

Therapeutic hypothermia saves approximately 1 in 7 newborn infants from death and disability.

64
Q

When does the neurological state predict outcome in cooled infants with HIE?

A

Neurological state predicts outcome in cooled infants only when it is very abnormal. A Thompson score above 15 at any time after 1 hour of life predicts a severely abnormal outcome, even in cooled infants.

65
Q

What are common developmental outcomes for infants who survive severe HIE?

A

Microcephaly, cerebral palsy, and developmental delay are common outcomes.

66
Q

What type of follow-up is needed for infants affected by severe HIE?

A

Multidisciplinary specialist follow-up is required for affected infants.

67
Q

When should neurological assessment be conducted for infants with severe HIE?

A

Neurological assessment at 18–22 corrected weeks is recommended to detect motor abnormalities

68
Q

Why is longer-term follow-up necessary for infants with severe HIE?

A

Longer-term follow-up to school age is required to detect all developmental and behavioral abnormalities that may occur.

69
Q

What signs are assessed by the Thompson HIE score?

A

Limb tone, level of consciousness, visible fits, posture, Moro reflex, grasp, suck, respiration, fontanelle

70
Q

How is limb tone assessed in the Thompson HIE score?

A

It is assessed as generally hypertonic, generally hypotonic, or flaccid.

71
Q

What are the different levels of consciousness assessed in the Thompson HIE score?

A

Hyper-alert/staring/excessive irritability, lethargic, comatose or stuporose.

72
Q

How are visible fits assessed in the Thompson HIE score?

A

They are categorized as infrequent (< 3/day) or frequent (> 2/day).

73
Q

They are categorized as infrequent (< 3/day) or frequent (> 2/day).

A

Fisting and/or cycling, strong distal flexion, decerebrate.

74
Q

How is the Moro reflex assessed in the Thompson HIE score?

A

It is assessed as partial or absent.

75
Q

What is evaluated in terms of grasp and suck in the Thompson HIE score?

A

Grasp is categorized as poor or absent, while suck is assessed as poor, absent, and/or bites.

76
Q

What aspects of respiration are considered in the Thompson HIE score?

A

It evaluates hyperventilation, transient apnea, apnea requiring IPPV.

77
Q

How is the fontanelle assessed in the Thompson HIE score?

A

It is evaluated as full and tense.

78
Q

How is the total score calculated in the Thompson HIE score?

A

The maximum score in each category based on the infant’s clinical signs in the previous 24 hours is recorded and then totaled for the day.

Neonate (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions