Paeds Cases · fetal-neonatal-and-perinatal
Hypoxic-ischaemic encephalopathy and therapeutic hypothermia — structured clinical encounter
Structured encounter testing the approach to an encephalopathic term infant eligible for cooling: Sarnat staging, the cooling eligibility assessment, the 72-hour protocol, supportive neurocare, and MRI prognostication.
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Station brief (candidate)
You are the neonatal registrar. A term infant (39 weeks, birthweight 3400 g) born after an emergency caesarean for placental abruption is admitted to the neonatal unit at 2 hours of age with lethargy, generalised hypotonia, and depressed Moro and suck reflexes. Cord blood pH was 6.88, base deficit 14 mmol/L. Apgar scores were 1, 3, and 5 at 1, 5, and 10 minutes, with ongoing mask ventilation at 10 minutes. The team asks you to assess cooling eligibility, establish the protocol, and outline the supportive neurocare. You have 12 minutes with the team and 5 minutes for examiner discussion. [1]
References6ShowHide
- [1]Sarnat HB; Sarnat MS Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol, 1976.PMID 987769
- [3]Shankaran S; Laptook AR; Ehrenkranz RA; et al Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med, 2005.PMID 16221780
- [4]Azzopardi DV; Strohm B; Edwards AD; et al Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med, 2009.PMID 19797281
- [5]Jacobs SE; Berg M; Hunt R; et al Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev, 2013.PMID 23440789
- [7]Barkovich AJ; Westmark KD; Partridge C; et al Perinatal asphyxia: MR findings in the first 10 days. AJNR Am J Neuroradiol, 1995.PMID 7793360
- [10]Douglas-Escobar M; Weiss MD Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr, 2015.PMID 25685948