CHAPTER 47 - Management of Hypoxic-Ischemic Encephalopathy Using Measures Other Than Therapeutic Hypothermia

Abstract

Neonatal encephalopathy (NE) is an alteration in consciousness or neurologic exam in the neonate. The possible etiologies of NE are broad, but it is most commonly caused by hypoxic-ischemic encephalopathy (HIE). The initial diagnosis of HIE relies on evidence of an acute or subacute (prolonged) perinatal event leading to brain injury and exam findings consistent with encephalopathy. Initial evaluation of an infant with suspected HIE should include perinatal history, biochemical assessment, and neurologic exam. Electroencephalogram (EEG) and imaging, when available, may confirm the diagnosis and severity. Although HIE occurs at all gestational ages, the assessment of encephalopathy in preterm infants is difficult and the clinical presentation of seizures may be subtle. Thus the search for a reliable, testable biomarker for outcome in HIE is the topic of ongoing research. Therapeutic hypothermia is the only available treatment for HIE in full-term infants thus far, which will be discussed in a separate chapter. Other neuroprotective strategies and future adjuvant therapies are discussed here.