Neonatology Hypoxic-Ischemic Encephalopathy, HIE.ppt

Neonatology: Hypoxic-Ischemic Encephalopathy, HIE Main Contents Clinical definition Etiology/High risk factors Pathogenesis and Pathophysiology Clinical manifestations and diagnostic Neuroimaging Prognosis Clinical Management Clinical definition Brain damage in Fetus and neonates caused by hypoxic and/or decreasing or abruption of blood flow to brain during perinatal period. Etiology Almost all the factors causing asphyxia resulting HIE, and Maternal Placenta and umbilicus abnormality Substantial pulmonary, cardiac and CNS disease of the fetus and neonates Pronged partum Medication during delivering High risk factors Prolonged fetal bradycardia Repeated late decelerations Low Apgar scores at 5 minutes or later Low fetal scalp or cord pH Requirement for prolonged resuscitation with positive-pressure ventilation Pathogenesis and Pathophysiology Change of cerebral blood flow normal term stable CBF: 50-60ml/min/100g CBF＜ 20ml/min /100g, brain damage Pathogenesis and Pathophysiology Change of cerebral metabolism Increase in anaerobic glycolysis Na +, Ca2 + pump function ? intracellular ATP exhausted Na +, Ca2 + endosmosis? Irritability amino acid? blocking oxidative phosphorylation in mitochondrion blood stream reperfusion? oxygen free radical ? Pathogenesis and Pathophysiology Change of nuropathology Term baby: cortex infarction gray matter in partes profunda necrosis Preterm: intraventricular haemorrhage white matter injury Cerebral inflammation IL-1, TNF-? , CKs ? Cellular apoptosis ? Clinical manifestations Mild excitation/ irritability Apparent at 24 hr No convulsion normal EEG Clinical manifestations Moderate Convulsion, 50% with disorder of consciousness Apparent at 24-48 hr Deterioration: intensity of anterior fontanelle coma Clinical manifestations Severe light coma or coma at birth Irregular respiration and apnea Convulsion with 12 hr Poor muscle tone Intensity of anterior fontanelle Most die in 1 wee