Hypoxic ischaemic encephalopathy (HIE) is the term for brain damage resulting from ante- or perinatal hypoxia.

Pathophysiology

• The lack of oxygen in the foetal circulation results in poor supply of oxygen to the brain.
• This ischaemia results in irreversible brain damage, both from primary neuronal death (immediate) and secondary reperfusion injury (delayed).

Aetiology

Any event causing poor oxygenation can cause HIE. Examples can be categorised based on when they occur:

• Pre-partum (e.g., placental abruption)
• During delivery (e.g., cord compression)
• Post-partum (e.g., prolonged respiratory arrest).

PC

• The presentation of HIE depends on the degree of neurological damage, ranging from mild (irritability) to severe (hypotonia, poor responses, prolonged seizures).

Investigations

• Investigation of HIE is with EEG monitoring and multiple MRI brain scans

Management

• Management of HIE depends on presentation and systemic complications that occur as a result of the ischaemia.
• Management includes respiratory support, anticonvulsant therapy, careful fluid balance and electrolyte monitoring, and potentially the use of inotropes.