89 Neonatal Encephalopathy

Cally Tann 13/11/18

What is neonatal encephalopathy? :

Best outcomes in gestatational age to prevent neonatal encephalopathy? : 39-41 Weeks

What imaging can you do to investigate a neonate for neonatal encephalopathy : Cranial Ultrasound showing changes in white matter: fluffy, bright swollen

Where in the brain is affected by hypoxia in obstructed labour?: First basal ganglia, then white matter

What are the three big causes of mortality age under 5 globally: Prematurity, Pnumonia, Intrapartum related events (in that order)

Birth Asphyxia : WHO Defn - Failure to initiate respiration at birth (Mothers in East Africa say babies were “tired at birth”)

Neonatal Encephalopathy : Broad Clinical Syndrome (not stating a cause)

Hypoxic ischaemic encephalopathy : When you are certain there was a period of hypoxia intrapartum, implies a cause of neonatal encephalopathy

What is the Thompson Score : A score to define patients with neonatal encephalopathy, examined on the first day (tone, consciousness, fits, primitive reflexes, respiration)

How do you identify kids with neonatal encephalopathy? : Use the Thompson Score on day one (but they will be at worst by day 3 - 4)

What grading of severity of neonatal encephalopathy is there? : Mild (Hyperalert, irritable, fisting) Moderate (Hypotonic, Lethargic, Seizures) Severe (Comatose, floppy, apnoeic, decerebrate) - Used to prognosticate with kids

How can you work out when a baby has a seizure? : It’s difficult, but babies don’t make purposeful movements, if it looks like they are they’re probably seizing. Look for mouth movements, eye movements

How do you stop a neonate from seizing? : Phenobarbitone (First load w/ 20 mg/kg, then 2 x doses 10 mg/kg)

How do you treat a child with neonatal encephalopathy: Resuscitation, Fluid restrict (40mg/kg/day), Prevent seizures, IV Abx, Avoid hypoglycaemia. In high income settings you would also cooled them to 33 degrees for 72 hours, it has a NNT of 6 (this has mortality risk in low income settings)

Why is cooling not necessarily a good idea for LMICs in neonatal encephalopathy? : Increased mortality (decreased monitoring, access to care), Less benefit (Hypoxic injury happening several hours before labour, too late for cooling)

What are the risk factors for neonatal encephalopathy? : Hypoxic Hit, Infection, Young Mum/First Labour, Obstructed Labour, No feotal monitoring

What’s the mortality in neonatal encephalopathy in LMICs : Around 1/4 (mostly occuring in first day)

What’s the morbiditiy in neonatal encephalopathy in LMICs : Around 60% by 2 years