Treatment

• Description

  • Current standard of care for neonates with moderate to severe HIE

  • Possible as selective head cooling or systemic hypothermia

  • Treatment at 33–35°C for 72 hours

  • Within the first 6 hours of life (therapeutic window)

• Eligibility criteria

  • Gestational age ≥ 36 weeks and ≤ 6 hours of age PLUS

  • pH ≤ 7 or base deficit of ≥ 16 mmol/L

  • PLUS either of the following

    • APGAR score at 10 min: ≤ 5 OR

    • Ongoing resuscitation at 10 min OR

    • Clinically moderate or severe encephalopathy

• Ensure sufficient oxygenation and ventilation (e.g., supplemental oxygen, inhaled nitric oxide, intubation).

• Maintain adequate organ perfusion (e.g., inotropic agents).

• Maintain electrolyte and glucose homeostasis.

• Anticonvulsive treatment of seizures

• Recent studies indicate a neuroprotective effect of erythropoietin in neonates with HIE. [10]

While maintaining adequate organ perfusion is important in children with HIE, volume overload should be avoided due to the possible subsequent development/worsening of brain edema.

• Cerebral palsy (most likely spastic quadriplegia or dyskinetic cerebral palsy)

• Periventricular leukomalacia (PVL)

• Epilepsy

• Specific learning disorders

• ADHD

• Intellectual developmental disorder

• Hearing and/or visual impairment

• Heart: impaired myocardial contractility

• Kidneys: acute renal failure

  • Mainly conservative treatment necessary

  • Theophylline has a nephroprotective effect

  • Dialysis in rare cases

  • Increased risk for the development of chronic kidney disease later in life

• Hematopoietic: bone marrow suppression, thrombocytopenia, disseminated intravascular coagulation

• Liver: elevated transaminase levels, hepatic injury

• Gastrointestinal tract: necrotizing enterocolitis in case of severe hypoperfusion

• Lungs: neonatal respiratory distress syndrome, pulmonary hypertension

• Mild encephalopathy: usually normal development

• Moderate to severe encephalopathy

  • Long-term neurologic manifestations

  • Severe abnormalities seen in MRI and EEG are associated with a poor outcome