What are the physical findings characteristic of severe 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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Stupor or coma is typical. The infant may not respond to any physical stimulus.

Breathing may be irregular, and the infant often requires ventilatory support.

Generalized hypotonia and depressed deep tendon reflexes are common.

Neonatal reflexes (eg, sucking, swallowing, grasping, Moro) are absent.

Disturbances of ocular motion, such as a skewed deviation of the eyes, nystagmus, bobbing, and loss of "doll's eye" (ie, conjugate) movements may be revealed by cranial nerve examination.

Pupils may be dilated, fixed, or poorly reactive to light.

Seizures are delayed, can be severe and may be initially resistant to conventional treatments. The seizures are usually generalized, and their frequency may increase during the 24-48 hours after onset, correlating with the phase of reperfusion injury. As the injury progresses, seizures subside and the EEG becomes isoelectric or shows a burst suppression pattern. At that time, wakefulness may deteriorate further, and the fontanelle may bulge, suggesting increasing cerebral edema.

Irregularities of heart rate and blood pressure (BP) are common during the period of reperfusion injury, as is death from cardiorespiratory failure.

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