Neonatal Hypothermia

A Method to Provide Neuroprotection After Hypoxic Ischemic Encephalopathy

Katherine M. Newnam, MS, RN, CPNP, NNP-BC; Donna L. DeLoach, MS, RN, CPNP, NNP-BC

Disclosures

NAINR. 2011;11(3):113-124. 

In This Article

Predictors of Hypoxic Injury

The seminal work by Sarnat and Sarnat[28] is considered the baseline or criterion standard for the measurement of HIE. Although specific parameters have been slightly modified by revisions to the original post–anoxic encephalopathy measure, the general features of the original tool continue to be widely used (see Table 2). Stages I, II, and III correlate with the degree of injury based on findings from 7 different categories. Serial measurements are obtained on the infant over several days to reflect the progressive state of encephalopathy in the term infant.[28] In those infants who are least affected, stage I has the best long-term outcome and typically requires the least intervention. Stage II, moderate encephalopathy, and stage III, severe encephalopathy, qualify for therapeutic hypothermia, and as stated earlier in the article, the moderate classification shows the most significant improvement when compared with like groups who received supportive care.[2,14,26,27]

According to the American College of Obstetricians and Gynecologist and American Academy of Pediatrics, the accepted criteria necessary for the diagnosis of moderate or severe encephalopathy in the term newborn after a hypoxic ischemic insult includes metabolic acidosis with a cord pH of 7.0 or less or a base deficit of at least 12 mmol/L, early onset of encephalopathy, and multisystem organ dysfunction with exclusion of other possible causes for findings. Additional clinical measurements such as amplitude integrated electroencephalography (aEEG) and MRI findings have been used as predictors of long-term outcomes and degree of injury (discussed in other sections of this article). Each measure described above, used in conjunction with careful clinical evaluation, should be used to both guide clinical treatment recommendations as well as offer best prognostic information to the family of the involved infant. In addition, long-term follow-up will be guided by ongoing evaluations of the infant's status and milestone achievement or delay.[9,29]

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