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[Hypoxic-ischemic encephalopathy in newborn infants. Acute period and outcome]
C A Funayama1, M V de Moura-Ribeiro, A L Gonçalves
1Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP/USP), Brasil.
Insights
Hypoxic ischemic encephalopathy (HIE) in neonates significantly impacts outcomes. Early neurological findings during the acute phase accurately predict long-term neurological sequelae and survival rates.
Area of Science:
- Neonatal neurology
- Perinatal medicine
- Pediatric neurology
Context:
- Hypoxic ischemic encephalopathy (HIE) is a major cause of neonatal mortality and morbidity.
- Long-term neurodevelopmental outcomes in HIE survivors are variable and challenging to predict.
- Understanding acute-phase neurological alterations is crucial for prognostication.
Purpose:
- To evaluate the correlation between acute-phase neurological alterations in neonates with HIE and their long-term neurological outcomes.
- To assess the predictive value of initial HIE severity grading on motor sequelae, epilepsy, and cognitive function.
- To analyze mortality rates and recovery patterns across different HIE severity grades.
Summary:
- A study of 94 neonates with HIE revealed distinct outcomes based on severity.
- HIE I showed minimal sequelae, HIE II had significant rates of cerebral palsy and neuromotor retardation, and HIE III resulted in mortality.
- Acute-phase neurological status strongly predicted long-term outcomes, including motor deficits and epilepsy.
Impact:
- Findings highlight the critical importance of early neurological assessment in managing HIE.
- Establishes a strong link between acute HIE phase findings and long-term neurological deficits.
- Informs clinical decision-making and therapeutic strategies for neonates with HIE.
Abstract:
Ninety four neonates with hypoxic ischemic encephalopathy HIE attended at the University of Ribeirão Preto since 1982 were studied in terms of the neurological alterations during the acute phase and outcome over a mean period of 47 months. From 43 newborns with HIE I, 40 recovered within 96 hours and 3 died. Among 40 infants with HIE II, 37.5% recovered within the first week, and the others continued abnormal beyond the 7th day. All 11 infants with HIE III died before the second month of life. The HIE I group had no motor sequelae. Among the HIE II group, 34.5% showed cerebral palsy and 17.7% neuromotor retardation. 80.0% of those with sequelae persisted abnormal beyond 7th day of life, during the acute phase of the HIE. Epilepsy occurred in 17.5% of cases with HIE grade II, only among those with neuromotor sequelae. The IQ test did not show statistically significant difference between the HIE I, II without motor sequelae and the control groups. The authors reaffirm the value of the findings in the acute phase of HIE on the outcome of these patients.