Chapter 3.5 management of infants with hypoxic ischaemic encephalopathy

Hypoxic ischaemic encephalopathy can result from lack of oxygen to vital organs before, during or immediately after birth. The initial treatment is effective resuscitation as above.

Problems during the days after birth:

  • Convulsions: Treat with phenobarbital; ensure hypoglycaemia is not present (check blood glucose).
  • Apnoea: common after severe birth asphyxia; sometimes associated with convulsions. Resuscitate with bag and mask, and manage with oxygen by nasal prongs.
  • Inability to suck: Feed with expressed breast milk via a nasogastric tube. Avoid delayed emptying of the stomach, which may lead to regurgitation of feeds.
  • Poor motor tone: floppy or with limb stiffening (spasticity)

Prognosis can be predicted by recovery of motor function and sucking ability. An infant who is normally active will usually do well. An infant who, within a week of birth, is still floppy or spastic, unresponsive and cannot suck has a severe brain injury and will do poorly. The prognosis is less grim for infants who have recovered some motor function and are beginning to suck. The situation should be sensitively discussed with parents throughout the time the infant is in hospital.