What is the prognosis of hypoxic-ischemic encephalopathy (HIE)?

Updated: Jul 18, 2018
  • Author: Santina A Zanelli, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Accurate prediction of the severity of long-term complications of hypoxic-ischemic encephalopathy (HIE) is difficult, although clinical, laboratory, and imaging criteria have been used. [24] The following criteria have been shown to be the most helpful in outlining likely outcomes:

  • Lack of spontaneous respiratory effort within 20-30 minutes of birth is almost always associated with death.

  • The presence of seizures is an ominous sign. The risk of poor neurologic outcome is distinctly greater in such infants, particularly if seizures occur frequently and are difficult to control.

  • Abnormal clinical neurologic findings persisting beyond the first 7-10 days of life usually indicate poor prognosis. Among these, abnormalities of muscle tone and posture (hypotonia, rigidity, weakness) should be carefully noted.

  • EEG at about 7 days that reveals normal background activity is a good prognostic sign.

  • Persistent feeding difficulties, which generally are due to abnormal tone of the muscles of sucking and swallowing, also suggest significant CNS damage.

  • Poor head growth during the postnatal period and the first year of life is a sensitive finding predicting higher frequency of neurologic deficits.

A Swedish retrospective population-based study comprising 692,428 live births of at least 36 gestational weeks found that more than a quarter (29%) of all HIE births were associated with an obstetric emergency, with parous women affected more than nulliparous women. [130]  The investigators noted a strong association of shoulder dystocia in nulliparas, and to uterine rupture in women with previous cesarean deliveries. [130]

Of note, the use of therapeutic hypothermia changes the prognostic value of clinical evaluation in infants with HIE, and its impact on predicting outcomes is still under evaluation. [25]

Other early predictors of long-term neurodevelopmental outcomes are being actively investigated. Early evidence indicates that biomarkers such as serum S100B and neuron-specific enolase may be helpful in identifying infants with severe brain injury who may be candidates for novel neuroprotective or neuroregenerative therapies. [26]

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