What are the symptoms of neonatal hypoxic ischemic encephalopathy

Neonatal hypoxic-ischemic encephalopathy (HIE) refers to a serious complication of cerebral hypoxia and/or ischemia caused by perinatal asphyxia (before or during delivery). So what are the clinical manifestations of neonatal hypoxic ischemic encephalopathy?

【Clinical manifestations】

It can be divided into three degrees: The following symptoms often occur within 12-24 hours after birth:

(1) Mild: Overexcitement, slightly active hug reflex, and normal muscle tone. The sucking reflex and fontanelle tone were normal. It lasts about 24 hours and improves within 3 days. The prognosis is good.

(2) Moderate: Drowsiness or dullness, decreased muscle tone, sucking reflex, and hugging reflex, often accompanied by convulsions, normal or slightly full tone of the anterior fontanelle, and mild central respiratory failure. Most cases will improve within a week, otherwise the prognosis will be serious.

(3) Severe: coma, loose muscle tone, disappearance of sucking and hugging reflexes, frequent convulsions, pupil changes, tense anterior fontanelle, and central respiratory failure. The mortality rate is high and survivors often have sequelae.

【Diagnosis points】

1. There is a history of perinatal hypoxia, such as maternal hypertension, gestational hypertension, increased intrauterine fetal movement, increased or decreased fetal heart rate, and contaminated amniotic fluid. Asphyxia after birth.

2. There are symptoms and signs of the nervous system.

3. Cranial ultrasound examination should be observed dynamically. In moderate to severe cases, the ventricles become narrow or disappear, and there are high-echo areas around the ventricles, especially behind the outer corners of the lateral ventricles (caused by leukomalacia and edema).

4. CT examination can be divided into the following types according to the low density range of white matter:

(1) Mild: scattered and focal low-density shadows distributed in both cerebral lobes.

(2) Moderate: Low-density shadows occur in more than two cerebral lobes, with blurred contrast between white and gray matter.

(3) Severe: Diffuse low-density shadows appear in the cerebral hemispheres, the boundary between gray and white matter disappears, and the lateral ventricles become narrower. May be accompanied by intracranial hemorrhage.

5. Magnetic resonance imaging (MRI) can detect hypoxic-ischemic brain damage, localized hemorrhage in the brain parenchyma, multiple cystic encephalomalacia, basal ganglia hemorrhage, periventricular softening, and whether myelin formation is delayed or abnormal, and can determine the patient's neurodevelopmental status.

6. Electroencephalogram and brainstem evoked potentials: The electroencephalogram shows rhythm disorders, spike-slow wave bursts on a low-amplitude background wave, or continuous diffuse activity; the appearance of "burst inhibition", "low potential", and "electrical quietness" indicates severe hypoxic-ischemic encephalopathy. Auditory and visual evoked potentials can also reflect post-hypoxia-ischemia damage to a certain extent.

7. Increased activity of serum CK-BB isoenzyme reflects brain tissue damage. Diagnosis should be based mainly on clinical examination items, and auxiliary examinations can be performed according to the needs of the disease, but not every item needs to be performed.