Management of hypoxic-ischemic encephalopathy - current issues for the paediatrician

Abstract

Perinatal asphyxia (PA) is defined as the deprivation of oxygen occurring around the time of birth. Hypoxic-ischemic encephalopathy (HIE) is an encephalopathy due to PA. Perinatal asphyxia and HIE are still associated with high morbidity and mortality rates. The use of therapeutic hypothermia (TH) commencing preferably within the first 6 hours of life – currently the only scientifically validated treatment modality for HIE – has been proven to reduce the mortality rate and disability. We discuss pathophysiology, diagnosis, neuroimaging, treatment, the impact of PA and TH on pharmacology, follow-up, and some remaining questions of PA and HIE. The purpose of this article is to guide the general pediatrician in selecting the patients for neuromonitoring and TH and inform them about the tools for outcome assessment and early intervention for those with high risk for impaired neurodevelopmental outcome.