Paeds Vivas · fetal-neonatal-and-perinatal
Hypoxic-ischaemic encephalopathy and therapeutic hypothermia — branching viva
Branching viva from the recognition of the encephalopathic term newborn through Sarnat staging and the cooling decision, the boundary of the 6-hour window, and the prognostic role of the MRI injury pattern.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the neonatal registrar on call. The midwife asks you to review a term infant who is 'not right' at two hours of age. The examiner releases information in stages about the eligible term infant, an infant presenting late, and an encephalopathic infant whose cord gas does not meet the criteria.
Station opening
Examiner: "Define hypoxic-ischaemic encephalopathy and explain how it differs from 'birth asphyxia'." [10]
Strong candidate (must-hit)
- Defines HIE as the clinical syndrome of brain dysfunction in the term newborn caused by perinatal hypoxia and ischaemia — a recognisable constellation of altered consciousness, abnormal tone, depressed reflexes, autonomic disturbance and seizures. Explains that "birth asphyxia" describes the insult (the deprivation of oxygen), whereas HIE is the resulting brain syndrome, and that not every asphyxiated infant develops HIE and not every encephalopathic infant was asphyxiated. [10]
Weak candidate
- "It's brain damage from a difficult birth." [10]
References7ShowHide
- [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
- [8]Laptook AR; Shankaran S; Tyson JE; et al Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial. JAMA, 2017.PMID 29067428
- [10]Douglas-Escobar M; Weiss MD Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr, 2015.PMID 25685948