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Updated: Aug 12, 2026
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
Survivors with bad outcome after hypoxic-ischaemic encephalopathy: full-term neonates compare unfavourably with
J Pfenninger1, D Bachmann, B P Wagner
1Paediatric Intensive Care Unit, University Children's Hospital, Inselspital, Bern, Switzerland.
Insights
Hypoxic-ischaemic encephalopathy (HIE) affects neonates and children, with similar overall outcomes. However, neonates had more survivors with poor outcomes, potentially due to developmental differences.
Area of Science:
- Neonatal Intensive Care
- Pediatric Intensive Care
- Neurology
Background:
- Hypoxic-ischaemic encephalopathy (HIE) is a critical condition in neonatal and pediatric intensive care, leading to significant mortality and long-term morbidity.
- Understanding factors influencing outcomes in HIE is crucial for improving patient management.
Purpose of the Study:
- To analyze outcomes in full-term neonates and children with HIE.
- To specifically investigate the impact of life support withdrawal on patient outcomes.
Main Methods:
- Retrospective analysis of HIE patients admitted between 1992-1996.
- HIE severity assessed using Sarnat stages (neonates) and coma duration (children).
- Outcomes evaluated using the Glasgow Outcome Scale; bad outcome defined as death or severe disability.
Main Results:
- In neonates (n=38), Sarnat stage, convulsions, EEG, cardiovascular failure, and MOD were associated with bad outcomes (27 cases, 14 deaths).
- In children (n=45), persistent coma, EEG, cardiovascular failure, liver dysfunction, and MOD predicted bad outcomes (36 cases, 33 deaths).
- Life support withdrawal preceded death in 9/14 neonates and 15/15 children.
Conclusions:
- Overall good and bad outcomes did not significantly differ between neonates and older children with HIE.
- Neonatal HIE cases showed a higher proportion of survivors with bad outcomes, even after life support withdrawal.
- Potential reasons for this difference include maturational and metabolic variations, and anatomical differences in the neonatal skull.
Unlabelled:
Hypoxic-ischaemic encephalopathy (HIE) is of major importance in neonatal and paediatric intensive care with regard to mortality and long-term morbidity. Our aim was to analyse our data in full-term neonates and children with special regard to withdrawal of life support and bad outcome.
Patients:
All patients with HIE admitted to our unit from 1992-96 were analysed. Criteria for HIE were presence of a hypoxic insult followed by coma or altered consciousness with or without convulsions. Severity of HIE was assessed in neonates using Sarnat stages, and in children the duration of coma. In the majority of cases staging was completed with electrophysiological studies. Outcome was described using the Glasgow Outcome Scale. Bad outcome was defined as death, permanent vegetative state or severe disability, good outcome as moderate disability or good recovery.
Results:
In the neonatal group (n = 38) outcome was significantly associated with Sarnat stages, presence of convulsions, severely abnormal EEG, cardiovascular failure, and multiple organ dysfunction (MOD). A bad outcome was observed in 27 cases with 14 deaths and 13 survivors. Supportive treatment was withdrawn in 14 cases with 9 subsequent deaths. In the older age group (n = 45) outcome was related to persistent coma of 24-48 h, severely abnormal EEG, cardiovascular failure, liver dysfunction and MOD. A bad outcome was found in 36 cases with 33 deaths and 3 survivors. Supportive treatment was withdrawn in 15 instances, all followed by death.
Conclusions:
Overall, neonates and older patients did not differ with regard to good or bad outcome. However, in the neonatal group there were significantly more survivors with bad outcome, either overall or after withdrawal of support. Possible explanations for this difference include variability of hypoxic insult, maturational and metabolic differences, and the more compliant neonatal skull, which prevents brainstem herniation.
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