Hypoxic Ischaemic Encephalopathy

Azzopardi is a researcher looking at HIE and hypothermia. Scarlatti wrote keyboard music. Sarlat is a place in France.

Only about 10% of cases of CP show evidence of HIE retrospectively. Equally, most cases of HIE do not go on to have CP.

Very poor specificity. 10 minute APGAR is a better predictor.

Fibronectin is a marker of preterm delivery. Cord doppler may suggest chronic placental insufficiency.

Hypoxia and ischaemia, obviously... But these act via the mechanisms above. Programmed cell death = apoptosis. Shearing from birth trauma may cause intracerebral haemorrhage with similar signs/symptoms.

Important to distinguish whether there is fluid overload or not, and then determine whether there is an absolute or relative deficiency of sodium.

Kernicterus is more likely to occur after HIE at a given bilirubin level, although the hyperbilirubinaemia is unrelated to the HIE.

Irritability and hypertonia are characteristic of mild HIE. Abnormal pupillary reflexes are seen in severe HIE.

Hypoechoic lesions suggest infarction. Slit like ventricles imply oedema. Calcified lesions are a late sign.

Clinical features are still really important in giving a prognosis, although MRI is helpful. USS doppler is a research technique currently.