Hypoxic ischemic encephalopathy is a stroke

Asphyxia in the perinatal period

Abstract

Newborn asphyxia is one of the most common causes of death in the neonatal period. Often the infant's respiratory center is inhibited prpartally due to the influence of drugs or medication, umbilical cords are wrapped during birth or the airways are obstructed postpartum. Asphyxia is most severe in the brain. Depending on the severity of the asphyxia, hypoxic-ischemic encephalopathy can result, which can lead to irreparable neurological damage, such as periventricular leucomalacia, which occurs particularly in premature infants. After a rapid evaluation of the asphyxia, immediate cooling of the patient for 72 hours should be initiated in order to keep the neurological damage as low as possible.

definition

  • Asphyxia (Greek from asphyxia = "stop of the pulse"): Describes a lack of oxygen in the blood, which is caused by insufficient gas exchange and is associated with hypercapnia and acidosis. In a narrower sense, the term is used for an oxygen deficiency in the perinatal period.
  • Hypoxic-ischemic encephalopathy (HIE): Describes the insufficient supply of oxygen (hypoxia) and blood (ischemia) to the brain tissue. It is the result of persistent asphyxia and is associated with neurological deficits.

Epidemiology

  • 3–9 / 1000 newborns have asphyxia, 10–20% of them develop cerebral palsy
  • Asphyxia accounts for a quarter of all neonatal deaths

Unless otherwise stated, the epidemiological data refer to Germany.

etiology

In most cases, asphyxia occurs during childbirth, but it can occur during pregnancy. Important and common causes are

Pathophysiology

Symptoms / clinic

Diagnosis

Sarnat score

  • Indication for hypothermia treatment if at least one criterion is met
    • Asphyxia criteria
      • APGAR score in the 10th minute
    • Encephalopathy Criteria

Further diagnostics

  • Laboratory parameters
  • CNS sonography
    • Perfusion measurement and morphological change
    • Based on the arterial flow profile: cerebral edema grade 1–3
  • MRI: long-term observation of morphological changes

therapy

  • Hypothermia treatment at 33.5 ° C body temperature for 72 hours
  • In case of respiratory failure: intubation and ventilation
  • For cardiac failure: begin resuscitation

Complications

The most important complications are mentioned. No claim to completeness.

forecast

  • Mild HIE: Almost always neurologically normal
  • Moderate HIE: 50–60% die or show moderate to severe neurological deficits *
  • Severe HIE: Around 80% die or have severe neurological deficits *

(* Deficits see under complications)

Coding according to ICD-10-GM version 2021

P20.-: Intrauterine hypoxia

P21.-: asphyxia during childbirth

Source: Based on the ICD-10-GM version 2021, DIMDI.

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