[Prognosis of neonatal hypoxic-ischemic encephalopathy: diagnostic methods and treatment]

Hypoxic-ischemic encephalopathy results from perinatal asphyxia and manifests through severe metabolic acidosis or neonatal depression requiring resuscitation. Since this remains a significant cause of mortality and neurodevelopmental disorders such as cerebral palsy and epilepsy, a multimodal evaluation integrating clinical, biochemical, neurophysiological, and neuroimaging parameters is required to determine the prognosis. In terms of clinical assessment, various scales can be applied, these are especially helpful in predicting the risk of adverse outcomes. The gold standard treatment for moderate and severe cases is therapeutic hypothermia, which must be initiated within the first 6 hours of life to significantly reduce death and neurodevelopmental impairments. However, this treatment is not recommended for infants under 34 weeks, as the risks outweigh the neuroprotective benefits in this population. Seizure management is paramount, as seizures represent an independent factor for poor prognosis. Regarding diagnostic imaging, magnetic resonance imaging performed between the fourth and fifth day of life constitutes a key tool. Deep gray matter involvement is the most robust marker of an adverse prognosis. Long-term prognosis must include prolonged followup to detect cognitive deficits, even if early evaluations were normal. Therefore, the systematic inclusion of these patients in follow-up and early intervention programs that promote brain plasticity is recommended, along with close communication with families for shared decision-making.