In the present study, we sought to investigate the efficacy of human neural stem cells derived from human embryonic stem cells in a rat model of neonatal HI and the mechanisms enhancing brain repair. [ncbi.nlm.nih.gov]

Case Study A 29-year-old woman presents at a local hospital in labor with her first child. She has had an uncomplicated 40-week gestation and at presentation is 6 cm dilated and 90 percent effaced; membranes are intact. [praxis.iuhealth.org]

In this review we briefly highlight the present and potential forthcoming therapeutic treatments aimed at attenuation of the detrimental effects of neonatal hypoxia-ischemia. [ingentaconnect.com]

• Hypothermia

  Experiments have been performed on various depths and levels of hypothermia to explore neuroprotection. [ncbi.nlm.nih.gov]

  Hypothermia can be applied to the head only (Cool Cap) or to the entire body (whole body hypothermia [WBH]). [praxis.iuhealth.org]

  Therapeutic Hypothermia Also known as: Hypothermia after cardiac arrest, hypothermia after hypoxic-ischemic brain injury Related conditions: Hypothermia for traumatic brain injury, intracranial pressure management, acute ischemic stroke 1. [clinicaladvisor.com]

  Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med. 2014 Jul 10. 371(2):140-9. [Medline]. Laptook AR. Use of therapeutic hypothermia for term infants with hypoxic-ischemic encephalopathy. [emedicine.medscape.com]

• Disability

  including cerebral palsy, intellectual disabilities, and hearing deficit. [praxis.iuhealth.org]

  Neonatal hypoxic-ischemic (HI) brain injury leads to high mortality and neurodevelopmental disabilities. [ncbi.nlm.nih.gov]

  Public Health Relevance Hypoxic-Ischemic Encephalopathy (HIE) and White-Matter Injury are important complications in neonates that could lead to death or significant neurological disabilities. [grantome.com]

• Cerebral Palsy

  Cooling the brain in this way has been shown to prevent cerebral palsy or reduce the severity of the condition. [abclawcenters.com]

  Asphyxia was long thought to be the cause of Cerebral Palsy, but two studies have shown that only 9% of cases are a direct result of asphyxia. [cerebralpalsy.org]

  BACKGROUND AND PURPOSE: Hypoxic-ischemic (HI) brain injury in newborn infants represents a major cause of cerebral palsy, development delay, and epilepsy. [ncbi.nlm.nih.gov]

  In children, injury to the striatum results in the muscular abnormalities of cerebral palsy. Medium-spiny neurons constitute the major neuronal population of the striatum in both primates and rodents. [ourarchive.otago.ac.nz]

• Epilepsy

  Furthermore, no significant difference in genotype distribution was observed between patients with drug-resistant epilepsy and patients in remission in either the group with epilepsy but without HIE or in the group with epilepsy and HIE, although the [ncbi.nlm.nih.gov]

  Effects of HIE may include developmental delays, epilepsy, cognitive issues, motor skill development delays, and neurodevelopment delays. The true severity of HIE generally cannot be determined until the baby reaches three to four years of age. [birthinjuryguide.org]

  Some children will experience no health issues—or only mild or moderate effects—from HIE, while others have much more severe and permanent disability, such as developmental delay; cerebral palsy (motor impairment); epilepsy; or cognitive impairment. [ucsfbenioffchildrens.org]

  Treatment of post-hypoxic epilepsy and/or myoclonus follows that of other secondary epilepsies and myoclonus, and generally is similarly effective. [internationalbrain.org]

• Weakness

  Have feeding problems due to weak muscles in their mouth and throat. Have a weak cry. Show signs of organ dysfunction, especially of the heart, lungs, kidneys, liver and blood. [ucsfbenioffchildrens.org]

  There are a number of symptoms associated with HIE, including: Meconium-stained amniotic fluid Low heart rate Poor muscle tone Weak breathing or no breathing at all Bluish or pale skin color Excessive acid in the blood Tests to confirm HIE after symptoms [birthinjuryguide.org]

  Factors that can lead to fetal stroke include: Blood-clotting abnormalities Blocked blood flow in the placenta Malformed or weak blood vessels that may rupture Maternal high, or low, blood pressure Maternal infection, especially pelvic inflammatory disease [cerebralpalsy.org]

  Subsequent reperfusion to ischemic brain tissue may result in GMH from rupture of weak capillaries and increased venous pressure. [pediatricneurosciences.com]

  Yet hypotonia and weakness in proximal limbs, face, and bulbar musculature persist. [clinicalgate.com]

• Hypotension

  The exact nature of the injury depends on the severity of hypotension and the degree of brain maturation. [radiopaedia.org]

  Acidosis and hypoxia can cause decreased heart function, which can cause very low blood pressure ( hypotension ) and decreased blood flow to the brain ( ischemia ). [abclawcenters.com]

  Events that lead to asphyxia include, but are not limited to: Acute maternal hypotension Blood containing less oxygen due to poorly functioning lungs Cardiac complications Injury from cephalopelvic disproportion Injury from umbilical cord complications [cerebralpalsy.org]

  Severe hypotension most frequently injures the early myelinating and metabolically active thalami, dorsal brainstem, and anterior vermis. [ijri.org]

  Severely depressed respiratory and cardiac functions and signs of brainstem compression Reduced myocardial contractility, severe hypotension, cardiac dilatation, and tricuspid regurgitation are noted frequently in severe HIE. [slideshare.net]

• Hypertension

  Patients may have severe pulmonary hypertension requiring assisted ventilation. Renal failure presents as oliguria and, during recovery, as high-output tubular failure, leading to significant water and electrolyte imbalances. [slideshare.net]

  Therapeutic hypothermia is also a treatment option for refractory intracranial hypertension with good evidence for efficacy but few outcome data to support overall benefit vs. harm. [clinicaladvisor.com]

  Some doctors are also looking into drug-induced hypertension. Hyperbaric oxygen might work in some circumstances as it might reduce the overall systemic inflammatory response. [autoaccident.com]

  Women appear to be at increased risk for silent stroke, with hypertension and current cigarette smoking being predisposing factors. [14] [15] Pre- and postnatal [ edit ] Hypoxic-anoxic events may affect the fetus at various stages of fetal development [en.wikipedia.org]

  […] synthase (iNOS and nNOS), as well as endothelial NOS, may narrow the autoregulatory window, and downregulation of prostaglandin receptors in response to high circulating prostaglandin levels may blunt the prostaglandin-mediated vasoconstrictive response to hypertension [clinicalgate.com]

• Prolapse

  Conditions such as the cord being wrapped around the baby’s neck ( nuchal cord ), umbilical cord prolapse and placental abruption can cause a lack of oxygen to the baby’s brain and birth asphyxia. [abclawcenters.com]

  The findings suggest acute encephalopathy following cord prolapse, and she is transferred to the NeuroNICU at Riley Hospital for Children at Indiana University Health at 4.5 hours after birth. [praxis.iuhealth.org]

  […] functioning lungs Cardiac complications Injury from cephalopelvic disproportion Injury from umbilical cord complications Impaired blood flow to the brain during birth Interruption in breathing or poor oxygen supply Intrapartum hemorrhage Medical negligence Prolapsed [cerebralpalsy.org]

  Problems during the labor and delivery process involve umbilical cord occlusion and umbilical cord torsion or prolapse. It also includes rupture of the uterus and the placenta. [autoaccident.com]

  […] may be caused by fetal factors (fetal bradycardia, fetal thrombosis, and fetal hemorrhage), maternal factors (preeclampsia, abruptio-placentae, maternal hypotension, severe anemia, asthma and chronic vascular disease), or tight nuchal cord and cord prolapse [pediatricneurosciences.com]

• Visual Impairment

  This may be due to injury to the posterior visual pathway, including the primary visual cortex, resulting in “cortical visual impairment” [ Van Hof-van Duin and Mohn, 1984 ]. [clinicalgate.com]

  Watershed infarctions occurring the posterior portions of the cerebral hemispheres may produce disturbances in sensory function, and particularly impairments of visual processing. [internationalbrain.org]

  Watershed pattern is associated with predominant cognitive, visual, language, behavioral, and seizure problems at a median age of 2 years. [24], [25] The most common long-term neurologic outcome of PVL is motor and visual impairment. [ijri.org]

• Hearing Impairment

  Moreover, it is also a notable risk factor for hearing impairments which affect neonates.Insult from hypoxia-ischemia causes immediate neuronal injury and exhaustion of cellular energy stores, as the main cause of HI brain injury is the deprivation of [dialnet.unirioja.es]

  During cerebral hypoxia-ischemia, the uptake of glutamate the major excitatory neurotransmitter of the mammalian brain is impaired. [emedicine.medscape.com]

• Encephalopathy

  Post-mortem (PM) magnetic resonance imaging (MRI) is increasingly used as an alternative to conventional autopsy in babies dying from neonatal encephalopathy. [ncbi.nlm.nih.gov]

  When does hypoxic-ischemic encephalopathy occur? Hypoxic-ischemic encephalopathy is most common in full-term infants, although it does occur in premature infants, as well. [cerebralpalsy.org]

  [HIE] P91.60 …… unspecified P91.61 Mild hypoxic ischemic encephalopathy [HIE] P91.62 Moderate hypoxic ischemic encephalopathy [HIE] P91.63 Severe hypoxic ischemic encephalopathy [HIE] P91.8 Other specified disturbances of cerebral status of newborn P91.81 [icd10data.com]

  encephalopathy NE — neonatal encephalopathy OR — odds ratio PROM — prolonged rupture of membranes TOBY — Total Body Hypothermia for Neonatal Encephalopathy Accepted July 19, 2013. [pediatrics.aappublications.org]

  Additional Reading on Hypoxic-Ischemic Encephalopathy: Free Case Review How to Find the Right Hypoxic Ischemic Encephalopathy Lawyers for Your Case Our Verdicts and Settlements Our Past Hypoxic Ischemic Encephalopathy Cases HIE Help Center™ Hypothermia [abclawcenters.com]

• Seizure

  The magnitude of effect varied with seizure severity; children with severe seizures had a lower FSIQ than those with mild/moderate seizures (P < .0001). [ncbi.nlm.nih.gov]

  Seizures should be treated with phenobarbital or lorazepam; phenytoin may be added if either of these medications fails to control the seizures. 20. [slideshare.net]

  In addition, we will look for signs of seizures using a video camera. Show More Learn More Interview with Dr. [ucsfbenioffchildrens.org]

  HIE and PVL usually start to occur during the birthing process, with problems such as seizures and poor feeding starting to occur shortly after delivery. [abclawcenters.com]

  The presence of seizures is an ominous sign. The risk of poor neurologic outcome is distinctly greater in such infants, particularly if seizures occur frequently and are difficult to control. [emedicine.medscape.com]

• Paresis

  An uncommon but remarkable post-hypoxic motor syndrome is the ‘man in a barrel’ syndrome, or bibrachial paresis; this condition is characterized by bilateral proximal upper extremity paresis with preservation of lower extremity function, and reflects [internationalbrain.org]

• Lethargy

  Also note subacute SDH in the right frontal region and anterior interhemispheric fissure (arrow) Click here to view Cerebral sinovenous thrombosis (CSVT) should be suspected in neonates presenting with seizures and/or lethargy and without a history of [ijri.org]

Neuroimaging with cranial ultrasound (US), computed tomography and magnetic resonance imaging are valuable tools in the workup of patients with HIE. [pediatricneurosciences.com]

Electroencephalography (EEG) - Standard and amplitude-integrated EEG Hearing test - An increased incidence of deafness has been found among infants with hypoxic-ischemic encephalopathy who require assisted ventilation Retinal and ophthalmic examination See Workup [emedicine.medscape.com]

• Base Deficit

  Apgar scores are 0/0/2/3/4, and venous cord blood gases are: pH 6.85, pCO 2 98 mm Hg, pO 2 = 3 12 mEq/L, base deficit (BD) 24 mEq/L. The infant is intravenously given two boluses of normal saline. [praxis.iuhealth.org]

  Abbreviations: AS-Apgar score, BBB-blood-brain barrier, BE-base deficit, BW-birth weight, CSF-cerebrospinal fluid, EPO- erythropoietin, GA-gestational age, GPX-glutathion peroxidase, HIE-hypoxic-ischemic encephalopathy, HIF-1-hypoxia-inducible factor [bmj.com]

This makes it impossible for physicians to develop a definitive treatment for neonatal cases of HIE. The basic goal of HIE treatment is to support the baby’s affected organs. [birthinjuryguide.org]

The only available effective treatment, hypothermia, neither provides complete brain protection nor stimulates the repair necessary for neurodevelopmental outcome. [ingentaconnect.com]

Treatment of infants with HIE remains generally supportive with attention to resuscitation, fluid and electrolyte homeostasis, maintenance of acid-base balance, nutrition and feeding issues and treatment of seizures. [ncbi.nlm.nih.gov]

The treatment is called hypothermia (brain cooling) treatment and research shows that it halts almost every injurious process that starts to occur when the brain experiences an oxygen-depriving insult. [abclawcenters.com]

For preterm infants, compared with term infants, the overall prognosis is worse. [radiopaedia.org]

[…] injury in term and preterm neonates, the treatment and the prognosis. [pediatricneurosciences.com]

The present results should offer important insights into the prognosis for hypoxic-ischemic encephalopathy. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology. [ncbi.nlm.nih.gov]

Abnormal clinical neurological findings persisting beyond the first 7-10 days of life usually indicate poor prognosis. Among these, abnormalities of muscle tone and posture (hypotonia, rigidity, weakness) should be carefully noted. [slideshare.net]

Most deaths occur in the first days after birth due to multiple organ failure or redirection of care to comfort measures as a result of the grim prognosis. [emedicine.medscape.com]

Clinical Management As many etiologies of neonatal encephalopathy have specific therapies, the clinician’s initial task is to determine the underlying etiology through careful history taking, neurological examination, and laboratory and brain imaging [clinicalgate.com]

Etiology of neonatal seizures. NeoReviews. 2004 Aug. 5(8):e327. [Full Text]. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976 Oct. 33(10):696-705. [Medline]. [emedicine.medscape.com]

TIAs share the same underlying etiology as strokes; a disruption of cerebral blood flow. [en.wikipedia.org]

The major etiologies for this type of injury are prolonged difficult delivery and long standing antenatal risk factors. Again, DWI is the earliest to change and show cortical and subcortical white matter restriction [Figure 14] A. [ijri.org]

Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86(6):329-338. Drury PP, Bennet L, Gunn AJ. Mechanisms of hypothermic neuroprotection. Semin Fetal Neonatal Med. 2010;15(5):287-292. [praxis.iuhealth.org]

Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev 2010;86:329-38. [ PUBMED ] 2. Barkovich AJ, editor. Brain and spine injuries in infancy and childhood. In: Pediatric Neuroimaging. 4 th ed. [pediatricneurosciences.com]

In a review of the literature, Graham et al found that cerebral palsy is associated with intrapartum hypoxia-ischemia in only 14.5% of cases. [21] Epidemiology United States data In the United States and in most technologically advanced countries, the [emedicine.medscape.com]

CONCLUSIONS: SHED transplantation into the HI-injured brain resulted in remarkable neurological and pathophysiological recovery. [ncbi.nlm.nih.gov]

"Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms." NeuroRehabilitation 26 (1): 5-13. Calvert, J. W. and J. H. Zhang (2005). "Pathophysiology of an hypoxic-ischemic insult during the perinatal period." [internationalbrain.org]

Berger R, Garnier Y: Pathophysiology of perinatal brain damage. Brain Res Brain Res Rev 1999 Aug; 30(2): de Haan HH, Hasaart TH: Neuronal death after perinatal asphyxia. [slideshare.net]

This excessive NO production plays an important role in the pathophysiology of perinatal hypoxic-ischemic brain injury. [emedicine.medscape.com]

Application of this knowledge will allow us to identify strategies for early intervention and prevent the course of damage caused by hypoxic-ischemic injury. Copyright 2001 Harcourt Publishers Ltd. [ncbi.nlm.nih.gov]

Prevent hypoxia, hypercapnia, and hypocapnia; the latter is due to inadequate hyperventilation, which may lead to severe hypoperfusion of the brain. [slideshare.net]