Neonatal encephalopathy

Neonatal encephalopathy (NE) also known as Hypoxic and ischemic brain injury in the newborn, perinatal asphyxia, neonatal hypoxic and ischemic brain injury.

An encephalopathy syndrome with signs and symptoms of abnormal neurological function, in the first few days of life in an infant born after 35 weeks of gestation.

NE refers to neurologic dysfunction from a reduction of oxygen and blood flow to a fetus’s brain near the time of birth and is an important cause of brain injury in term and near term infants.

It affects more than 10,000 infants each year in the US, or one to three births per 1000 births, and accounts with 22% of neonatal deaths worldwide.

Manifestations include difficulty initiating and maintaining respirations, a subnormal level of consciousness, and associated depression of tone, reflexes, and possibly seizures.

The encephalopathy is a nonspecific response of the brain to injury: it may occur via multiple methods, but is commonly caused by birth asphyxia, leading to cerebral hypoxia.

Neonatal encephalopathy may present itself as the following symptoms:

Reduced level of consciousness


Difficulty initiating and maintaining respiration

Depression of tone and reflexes

Diagnosis and evaluation:

Cord blood gas analysis can determine if there is perinatal hypoxia/asphyxia, potential causes of hypoxic-ischemic encephalopathy or cerebral palsy, and provides insight into causes of intrapartum fetal distress.

Cord blood gas analysis is indicated for: high-risk pregnancies, in cases where C-sections occurred due to fetal compromise, if there were abnormal fetal heart rate patterns, Apgar scores of 3 or lower, intrapartum fever, or multifetal gestation.

NE evidenced brain injury related to the hypoxic-ischemic events can be seen with brain MRIs, CTs, magnetic resonance spectroscopy imaging or ultrasounds.

Features that can be seen on MRI brain are: periventricular leukomalacia, basal ganglia and thalamus lesions, and multicystic encephalopathy.

Neonatal encephalopathy is treated using hypothermia therapy.

It reduces brain damage, future disability, and improves survival.

Therapeutic hypothermia is the only neuroprotective therapy.

Therapeutic hypothermia improves neurodevelopmental outcomes in large trials.

Up to 40% of infants who receive hypothermia therapy die or have long-term disabilities including cerebral palsy and intellectual impairment.

Hypoxic neonatal encephalopathy is a major predictor of neurodevelopmental disability in term infants: 25 percent have permanent neurological deficits.

Overall, the relative incidence of neonatal encephalopathy is estimated to be between 2 and 9 per 1000 term births.

40% to 60% of affected infants die by 2 years old or have severe disabilities.

In 2013 it was estimated to have resulted in 644,000 global deaths.

The administration of erythropoietin to newborns undergoing therapeutic hypothermia does not result in lower death or neuro developmental impairment than placebo.

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