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16 - Clinical manifestations of hypoxic–ischemic encephalopathy

from Section 3 - Diagnosis of the infant with brain injury

Published online by Cambridge University Press:  12 January 2010

David K. Stevenson
Affiliation:
Stanford University School of Medicine, California
William E. Benitz
Affiliation:
Stanford University School of Medicine, California
Philip Sunshine
Affiliation:
Stanford University School of Medicine, California
Susan R. Hintz
Affiliation:
Stanford University School of Medicine, California
Maurice L. Druzin
Affiliation:
Stanford University School of Medicine, California
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Summary

Introduction

Hypoxic–ischemic encephalopathy (HIE) is a well-recognized clinical syndrome and the most common cause of acute neurological impairment and seizures in the neonatal period. Neonatal encephalopathy is a term used to describe newborns with acute neurological syndromes and encephalopathy that may be caused by diverse processes including hypoxia–ischemia, infections, inflammation, trauma, and metabolic disorders. Neonatal encephalopathy due to perinatal asphyxia can lead to neurological sequelae and cerebral palsy, but recent literature has shown that only a small percentage of children with cerebral palsy had intrapartum asphyxia as a possible etiology. More emphasis has been placed on antenatal events as having a greater association with cerebral palsy. Although newborns with neonatal encephalopathy may have antenatal risk factors associated with other findings, such as delayed onset of respiration, arterial cord blood pH less than 7.1, and multiorgan failure, the MRI most often shows signs of acute perinatal insult. Therefore, hypoxic–ischemic injury during the perinatal period can lead to a neurological syndrome in the newborn period, i.e., HIE, and subsequent neurological sequelae in the survivors. Recognizing and understanding hypoxic–ischemic encephalopathy are therefore important.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2009

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References

Finer, NN, Robertson, CM, Peters, KL, et al. Factors affecting outcome in hypoxic–ischemic encephalopathy in term infants. Am J Dis Child 1983; 137: 21–5.Google ScholarPubMed
Finer, NN, Robertson, CM, Richards, RT, et al. Hypoxic–ischemic encephalopathy in term neonates: perinatal factors and outcome. J Pediatr 1981; 98: 112–17.CrossRefGoogle ScholarPubMed
Mizrahi, EM, Kellaway, P. Characterization and classification of neonatal seizures. Neurology 1987; 37: 1837–44.CrossRefGoogle ScholarPubMed
Roland, EH, Hill, A. Clinical aspects of perinatal hypoxic–ischemic brain injury. Semin Pediatr Neurol 1995; 2: 57–71.CrossRefGoogle ScholarPubMed
Vannucci, R. Hypoxic–ischemic encephalopathy. Am J Perinatol 2000; 17: 113–20.CrossRefGoogle ScholarPubMed
Blair, E, Stanley, FJ. Intrapartum asphyxia: a rare cause of cerebral palsy. J Pediatr 1988; 112: 515–19.CrossRefGoogle ScholarPubMed
Nelson, KB, Ellenberg, JH. Antecedents of cerebral palsy: multivariate analysis of risk. N Engl J Med 1986; 315: 81–6.CrossRefGoogle Scholar
Nelson, KB. What proportion of cerebral palsy is related to birth asphyxia?J Pediatr 1988; 112: 572–4.CrossRefGoogle ScholarPubMed
Naeye, RL, Peters, EC. Antenatal hypoxia and low IQ values. Am J Dis Child 1987; 141: 50–4.Google ScholarPubMed
Cowan, F, Rutherford, M, Groenendaal, F, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 2003; 361: 736–42.CrossRefGoogle ScholarPubMed
Allan, WC, Riviello, JJ. Perinatal cerebrovascular disease in the neonate. Pediatr Clin North Am 1992; 39: 621–50.CrossRefGoogle ScholarPubMed
Levene, MI, Grindulis, H, Sands, C, et al. Comparison of two methods of predicting outcome in perinatal asphyxia. Lancet 1986; 1: 67–9.CrossRefGoogle ScholarPubMed
Sarnat, HB, Sarnat, MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol 1976; 33: 696–705.CrossRefGoogle ScholarPubMed
Shankaran, S, Laptook, AR, Ehrenkranz, RA, et al. Whole-body hypothermia for neonates with hypoxic–ischemic encephalopathy. N Engl J Med 2005; 353: 1574–84.CrossRefGoogle ScholarPubMed
Hill, A, Volpe, JJ. Perinatal asphyxia: clinical aspects. Clin Perinatol 1989; 16: 435–57.CrossRefGoogle ScholarPubMed
Robertson, C, Finer, N. Term infants with hypoxic–ischemic encephalopathy: outcome at 3.5 years. Dev Med Child Neurol 1985; 27: 473–84.CrossRefGoogle ScholarPubMed
Ishikawa, T, Ogawa, Y, Kanayama, M, et al. Long-term prognosis of asphyxiated full-term neonates with CNS complications. Brain Dev 1987; 9: 48–53.CrossRefGoogle ScholarPubMed
Hill, A. Current concepts of hypoxic–ischemic cerebral injury in the term newborn. Pediatr Neurol 1991; 7: 317–25.CrossRefGoogle ScholarPubMed
Fernandez, F, Verdu, A, Quero, J, et al. Cerebrospinal fluid lactate levels in term infants with perinatal hypoxia. Pediatr Neurol 1986; 2: 39–42.CrossRefGoogle ScholarPubMed
Nylund, L, Dahlin, I, Lagercrantz, H. Fetal catecholamines and the Apgar score. J Perinat Med 1987; 15: 340–4.CrossRefGoogle ScholarPubMed
Takeuchi, T, Watanabe, K. The EEG evolution and neurological prognosis of neonates with perinatal hypoxia. Brain Dev 1989; 11: 115–20.CrossRefGoogle ScholarPubMed
Scher, MS, Painter, MJ, Bergman, I, et al. EEG diagnosis of neonatal seizures: clinical correlations and outcome. Pediatr Neurol 1989; 5: 17–24.CrossRefGoogle ScholarPubMed
Majnemer, A, Rosenblatt, B, Riley, P, et al. Somatosensory evoked response abnormalities in high-risk newborns. Pediatr Neurol 1987; 3: 350–5.CrossRefGoogle ScholarPubMed
Majnemer, A, Rosenblatt, B, Riley, PS. Prognostic significance of multimodality evoked response testing in high-risk newborns. Pediatr Neurol 1990; 6: 367–74.CrossRefGoogle ScholarPubMed
Stockard, JE, Stockard, JJ, Kleinberg, F, et al. Prognostic value of brainstem auditory evoked responses in neonates. Arch Neurol 1983; 40: 360–5.CrossRefGoogle ScholarPubMed
Whyte, HE, Taylor, MJ, Menzies, R, et al. Prognostic utility of visual evoked potentials in term asphyxiated neonates. Pediatr Neurol 1986; 2: 220–3.CrossRefGoogle ScholarPubMed
Toet, MC, Hellström-Westas, L, Groenendaal, F, et al. Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1999; 81: F19–23.CrossRefGoogle Scholar
Kuenzle, C, Baenziger, O, Martin, E, et al. Prognostic value of early MR imaging in term infants with severe perinatal asphyxia. Neuropediatrics 1994; 25: 191–200.CrossRefGoogle Scholar
Baenziger, O, Martin, E, Steinlin, M, et al. Early pattern recognition in severe perinatal asphyxia: a prospective MRI study. Neuroradiology 1993; 35: 437–42.CrossRefGoogle ScholarPubMed
Triulzi, F, Parazzini, C, Righini, A. Patterns of damage in the mature neonatal brain. Pediatr Radiol 2006; 36: 608–20.CrossRefGoogle ScholarPubMed
Hüppi, PS, Murphy, B, Maier, SE, et al. Microstructural brain development after perinatal cerebral white matter injury assessed by diffusion tensor magnetic resonance imaging. Pediatrics 2001; 107: 455–60.CrossRefGoogle ScholarPubMed
Robertson, RL, Ben-Sira, L, Barnes, PD, et al. MR line-scan diffusion-weighted imaging of term neonates with perinatal brain ischemia. Am J Neuroradiol 1999; 20: 658–70.Google ScholarPubMed
Myer, JE. Uber die Lokalisation frühkindlicher Hirnshäden in arteriellen Grenzgebieten. Arch Psychiatr Zeitschr Neurol 1953; 190: 328–41.Google Scholar
Volpe, JJ, Herscovitch, P, Perlman, JM, et al. Positron emission tomography in the asphyxiated term newborn: parasagittal impairment of cerebral blood flow. Ann Neurol 1985; 17: 287–96.CrossRefGoogle ScholarPubMed
Volpe, JJ, Pasternak, JF. Parasagittal cerebral injury in neonatal hypoxic–ischemic encephalopathy: clinical and neuroradiological features. J Pediatr 1979; 91: 472–6.CrossRefGoogle Scholar
Friede, RL. Developmental Neuropathology, 2nd edn. New York, NY: Springer-Verlag, 1989.CrossRefGoogle Scholar
Voit, T, Lemburg, P, Neuen, E, et al. Damage of thalamus and basal ganglia in asphyxiated full-term neonates. Neuropediatrics 1987; 18: 176–81.CrossRefGoogle ScholarPubMed
Johnston, MV, Hoon, AH. Possible mechanisms in infants for selective basal ganglia damage from asphyxia, kernicterus, or mitochondrial encephalopathies. J Child Neurol 2000; 15: 588–91.CrossRefGoogle ScholarPubMed
Malamud, N, Hirano, A. Atlas of Neuropathology, 2nd edn. Berkeley, CA: University of California Press, 1974.Google Scholar
Gilles, FH. Hypotensive brain stem necrosis: selective symmetrical necrosis of tegmental neuronal aggregates following cardiac arrest. Arch Pathol 1969; 88: 32–41.Google ScholarPubMed
Rorke, LB. Pathology of Perinatal Brain Injury. New York, NY:Raven Press, 1982.Google Scholar
Roland, EH, Hill, A, Norman, MG, et al. Selective brainstem injury in an asphyxiated newborn. Ann Neurol 1988; 23: 89–92.CrossRefGoogle Scholar
Pasternak, JF, Gorey, MT. The syndrome of acute near-total intrauterine asphyxia in the term infant. Pediatr Neurol 1998; 18: 391–8.CrossRefGoogle ScholarPubMed
Natsume, J, Watanabe, K, Kuno, K, et al. Clinical, neurophysiologic, and neuropathological features of an infant with brain damage of total asphyxia type (Myers). Pediatr Neurol 1995; 13: 61–4.CrossRefGoogle Scholar
Barmada, MA, Moossy, J, Shuman, RM. Cerebral infarcts with arterial occlusion in neonates. Ann Neurol 1979; 6: 495–502.CrossRefGoogle ScholarPubMed
Banker, BQ. Cerebral vascular disease in infancy and childhood. I. Occlusive vascular disease. J Neuropathol Exp Neurol 1961; 20: 127–40.CrossRefGoogle Scholar
Clancy, R, Malin, S, Laraque, D, et al. Focal motor seizures heralding stroke in full-term neonates. Am J Dis Child 1985; 139: 601–6.Google ScholarPubMed
Koelfen, W, Freund, M, Varnholt, V. Neonatal stroke involving the middle cerebral artery in term infants: clinical presentation, EEG and imaging studies, and outcome. Dev Med Child Neurol 1995; 37: 204–12.CrossRefGoogle ScholarPubMed
Levine, SC, Huttenlocher, P, Banich, MT, et al. Factors affecting cognitive function of hemiplegic children. Dev Med Child Neurol 1987; 29: 27–35.CrossRefGoogle ScholarPubMed
Rivkin, MJ, Anderson, ML, Kaye, EM. Neonatal idiopathic cerebral venous thrombosis: an unrecognized cause of transient seizures or lethargy. Ann Neurol 1992; 32: 51–6.CrossRefGoogle ScholarPubMed
Wong, VK, LeMesurier, J, Franceschini, R, et al. Cerebral venous thrombosis as a cause of neonatal seizures. Pediatr Neurol 1987; 3: 235–7.CrossRefGoogle ScholarPubMed
Banker, BQ, Larroche, JC. Periventricular leukomalacia of infancy. Arch Neurol 1962; 7: 386–410.CrossRefGoogle ScholarPubMed
Guzzetta, F, Shackleford, GD, Volpe, S, et al. Periventricular intraparenchymal echodensities in the premature newborn: critical determination of neurologic outcome. Pediatrics 1986; 78: 995–1006.Google ScholarPubMed
Fawer, CL, Calame, A, Perentes, E, et al. Periventricular leukomalacia: a correlation study between real-time ultrasound and autopsy findings. Neuroradiology 1985; 27: 292–300.CrossRefGoogle ScholarPubMed
Trounce, JQ, Rutter, N, Levene, MI. Periventricular leucomalacia and intraventricular haemorrhage in the preterm neonate. Arch Dis Child 1986; 16: 1196–202.CrossRefGoogle Scholar
Trounce, JQ, Shaw, , Leverne, MI, et al. Clinical risk factors and periventricular leucomalacia. Arch Dis Child 1988; 63: 17–22.CrossRefGoogle ScholarPubMed
Vries, LS, Connell, JA, Dubowitz, LMS, et al. Neurological, electrophysiological and MRI abnormalities in infants with extensive cystic leukomalacia. Neuropediatrics 1987; 18: 61–6.CrossRefGoogle ScholarPubMed
Dolfin, T, Skidmore, MB, Fong, KW, et al. Incidence, severity, and timing of subependymal and intraventricula hemorrhages in preterm infants born in a perinatal unit as detected by serial real-time ultrasound. Pediatrics 1983; 71: 541–6.Google Scholar
Enzmann, D, Murphy-Irwin, K, Stevenson, D, et al. The natural history of subependymal germinal matrix hemorrhage. Am J Perinatol 1985; 2: 123–33.CrossRefGoogle ScholarPubMed
Scher, MS, Wright, FS, Lockman, , et al. Intraventricular haemorrhage in the full-term neonate. Arch Neurol 1982; 39: 769–72.CrossRefGoogle ScholarPubMed
Volpe, JJ. Intracranial hemorrhage: subdural, primary subarachnoid, intracerebellar, intraventricular (term infant), and miscellaneous. In Neurology of the Newborn, 4th edn. Philadelphia, PA: Saunders. 2001: 397–427.Google Scholar

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