Hypoxic-ischemic encephalopathy (HIE) - Definition, Stages, Prognosis: Notes, Slides, Video

 

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HIE is an insult to the fetus or newborn due to a lack of Oxygen (hypoxia) and / or a  lack of perfusion (ischemia) to various organs. It is often associated with tissue lactic acidosis and hypercarbia.

Hypoxia is an evolving process that starts at the onset of the insult and continues after resuscitation and thereafter manifests in form of sequelae

These manifestations change over time and are clinically noted in babies of gestational age more than 36 weeks by classification on the basis of Levene stages of HIE.

Stage 1 HIE / Mild HIE:

Irritability

Hypotonia 

Seizures Absent

Poor Suck

Stage 2 HIE / Moderate HIE:

Lethargy

Marked Hypotonia

Seizures Present

Unable to Suck

Stage 3 HIE / Severe HIE:

Comatose

Severe Hypotonia

Prolonged Seizures

Unable to sustain spontaneous respiration

Prognosis:

Stage 1: Good prognosis

Stage 2: 20% - Adverse neurological outcomes

Stage 3: 50% - Dies 50% - Poor neurodevelopmental outcomes.