Recommandé
Contenu connexe
Tendances
Tendances (20)
Similaire à Perinatal Asphyxia & Hypoxic Ischemic Encephalopathy.pptx
Similaire à Perinatal Asphyxia & Hypoxic Ischemic Encephalopathy.pptx (20)
Plus de zeinabnm
Plus de zeinabnm (14)
Dernier
Dernier (20)
Perinatal Asphyxia & Hypoxic Ischemic Encephalopathy.pptx
- 1. Perinatal Asphyxia & Hypoxic Ischemic Encephalopathy Zeinab Noormonavar Pharm D candidate 24/4/2022 1
- 2. Outline At the end of presentation you will be able to: • Recall definition, pathophysiology, symptoms of HIE. • Recommend appropriate treatment plan. • Discuss management of HIE. • Identify future prospect medications. 2
- 3. Background • Despite major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxic-ischemic encephalopathy (HIE), remains a serious condition that causes significant mortality and long-term morbidity. • HIE is characterized by clinical and laboratory evidence of acute or subacute brain injury due to asphyxia (i.e., hypoxia, acidosis). Most often, the exact timing and underlying cause remain unknown. 3 Neonatal hypoxic ischemic encephalopathy. ucsfbenioffchildrens.org. (n.d.). Retrieved April 28, 2022, from https://www.ucsfbenioffchildrens.org/conditions/neonatal- hypoxic-ischemic-encephalopathy#:~:text=Hypoxic%20ischemic%20encephalopathy%20(HIE)%20is,and%20encephalopathy%20means%20brain%20disorder.
- 4. Definition 4 Ohio hie lawyers pursue brain damage claims on behalf of newborns. Ohio HIE Lawyers | Infant Hypoxic Ischemic Encephalopathy. (n.d.). Retrieved April 28, 2022, from https://www.birthinjuryohio.com/brain-injuries/hie/
- 5. Assessment Apgar score of <5 at 5 minutes and 10 minutes Fetal umbilical artery pH <7.0, or base deficit ≥12 mmol/L, or both Acute brain injury seen on brain MRI Presence of multisystem organ failure (kidney, lung, liver, heart,…) 5 Assessment of Hypoxic ischemic Encephalopathy. Retrieved April 28, 2022, from https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(18)30051- 8/fulltext
- 6. Clinical Feature Abnormal state of consciousness (hyper-alert, irritable, lethargic, or obtunded) Diminished spontaneous movements Weak or absent cry Respiratory or feeding difficulty Poor tone Abnormal posturing Abnormal primitive reflexes Seizures 6 Allen, K. A., & Brandon, D. H. (2011, September 1). Hypoxic ischemic encephalopathy: Pathophysiology and experimental treatments. Newborn and infant nursing reviews : NAINR. Retrieved April 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171747/
- 7. 7 Clinical Feature – Sarnat Staging System Severity of hypoxic ischemic encephalopathy ... - researchgate. (n.d.). Retrieved April 28, 2022, from https://www.researchgate.net/publication/334575225_Severity_of_hypoxic_ischemic_encephalopathy_and_heart_rate_variability_in_neonates_A_systematic_review/fulltext/5d31fed5a6fdcc370 a4e8f7c/334575225_Severity_of_hypoxic_ischemic_encephalopathy_and_heart_rate_variability_in_neonates_A_systematic_review.pdf
- 8. Risk factors 8 Preconceptual • IDDM • Thyroid disease • Fertility treatments • Nulliparity • Advanced maternal age Antepartum • Severe pre-eclampsia • Placental abruption • IUGR • Hemorrhage Intrapartum • Breech • Cord prolapse • C-section • Induction • Maternal pyrexia Neonatal hypoxic ischemic encephalopathy. ucsfbenioffchildrens.org. (n.d.). Retrieved April 28, 2022, from https://www.ucsfbenioffchildrens.org/conditions/neonatal- hypoxic-ischemic-encephalopathy#:~:text=Hypoxic%20ischemic%20encephalopathy%20(HIE)%20is,and%20encephalopathy%20means%20brain%20disorder. IDDM: Insulin Dependent Diabetes Mellitus IUGR: Intra Uterine Growth Retardation
- 9. 9 Risk factors (Con’t) Nuchal cord Prolapsed cord Knotted cord Neonatal hypoxic ischemic encephalopathy. ucsfbenioffchildrens.org. (n.d.). Retrieved April 28, 2022, from https://www.ucsfbenioffchildrens.org/conditions/neonatal- hypoxic-ischemic-encephalopathy#:~:text=Hypoxic%20ischemic%20encephalopathy%20(HIE)%20is,and%20encephalopathy%20means%20brain%20disorder.
- 10. Pathophysiology 10 • Birth Injury: an injury that occurred during the process of birth • Birth Asphyxia: asphyxia that occurred during 2nd and 3rd stages of labor • Perinatal Asphyxia: asphyxia that occurred anytime between conception to first month of life.
- 11. 11 Pathophysiology (Con’t) Santina A Zanelli, M. D. (2021, April 3). Hypoxic-ischemic encephalopathy. Practice Essentials, Background, Pathophysiology. Retrieved April 28, 2022, from https://emedicine.medscape.com/article/973501-overview
- 12. Intervention and Therapies 12 Criteria • Gestational age ≥36 weeks and ≤6 hours of age And one of the following: 1. Metabolic or mixed acidosis with a pH of ≤7.0 or a base deficit of ≥16 mmol/L in a sample of umbilical cord blood or any blood obtained within the first hour after birth 2. A 10-minute Apgar score of ≤5 3. Ongoing resuscitation (eg, assisted ventilation, chest compressions, or cardiac medications) initiated at birth and continued for at least 10 minutes • Moderate to severe encephalopathy on clinical examination Guideline: Hypoxic ischaemic ... - queensland health. (n.d.). Retrieved April 28, 2022, from https://www.health.qld.gov.au/__data/assets/pdf_file/0014/140162/g-hie.pdf
- 13. Therapeutic Hypothermia • Must be initiated within 6 hours of birth • All external head sources off • Desired temperature: 33.5 ± 0.1 Centigrade • Monitor temperature every 15 minutes • Maintain for 72 hours 13 Intervention and Therapies Guideline: Hypoxic ischaemic ... - queensland health. (n.d.). Retrieved April 28, 2022, from https://www.health.qld.gov.au/__data/assets/pdf_file/0014/140162/g-hie.pdf
- 14. Whole Body Head Only 14 Intervention and Therapies Therapeutic Hypothermia Guideline: Hypoxic ischaemic ... - queensland health. (n.d.). Retrieved April 28, 2022, from https://www.health.qld.gov.au/__data/assets/pdf_file/0014/140162/g-hie.pdf
- 15. 1. Reduce metabolic rate and energy depletion. 2. Decrease excitatory transmission release. 3. Reduce alteration in ion flux. 4. Reduce apoptosis due to Hypoxic-Ischemic Encephalopathy 5. Reduce vascular permeability, edema, and disruption of BBB function. 15 Intervention and Therapies Therapeutic Hypothermia Abate, B. B., Bimerew, M., Gebremichael, B., Mengesha Kassie, A., Kassaw, M. W., Gebremeskel, T., & Bayih, W. A. (2021). Effects of therapeutic hypothermia on death among asphyxiated neonates with hypoxic-ischemic encephalopathy: A systematic review and meta-analysis of Randomized Control Trials. PLOS ONE, 16(2). https://doi.org/10.1371/journal.pone.0247229
- 16. Recommended lab Glucose CBC Blood culture PT, PTT, Fibrinog en ABG LFTs 16 Intervention and Therapies Therapeutic Hypothermia Douglas-Escobar, M., & Weiss, M. D. (2012, November 2). Biomarkers of hypoxic-ischemic encephalopathy in newborns. Frontiers in neurology. Retrieved April 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486976/
- 17. Arrhythmia • Bradycardia • Ventricular tachycardia Thrombocytopenia Persistent acidosis Bleeding Subcutaneous fat necrosis ± hypercalcemia Death 17 Intervention and Therapies Therapeutic Hypothermia’s Complication Texaschildrens.org ▷ Texas Children's Hospital. Webrate. (n.d.). Retrieved April 28, 2022, from https://webrate.org/index.php/site/texaschildrens.org/
- 18. • Warm slowly after 72 hours Monitor very closely • Increase temperature by 0.5 degree every hour Until reach 36.5 • Once temperature reaches 36.5 for 1 hour 18 Intervention and Therapies Rewarming Texaschildrens.org ▷ Texas Children's Hospital. Webrate. (n.d.). Retrieved April 28, 2022, from https://webrate.org/index.php/site/texaschildrens.org/
- 19. Supportive Management • Aside from treatment with therapeutic hypothermia, suggested management of neonatal encephalopathy includes the following recommendations: 19 Treat Seizure Phenobarbital Phosphenytoin Lorazepam Levetiracetam Ventilation Inhaled NO Extracorporeal membrane oxygenation Replace volume Use of inotropes Metabolic disorder Stop feeding Correct acidosis Vitamin supplementation if needed Maintain Euglycemia Guideline: Hypoxic ischaemic ... - queensland health. (n.d.). Retrieved April 28, 2022, from https://www.health.qld.gov.au/__data/assets/pdf_file/0014/140162/g-hie.pdf
- 20. Follow – Up Developmental pediatric consult & evaluation prior to discharge Neurology clinic post discharge Brain MRI at 1 year of age Developmental clinic at 6 months, 1 year, and 18 months (Bayley exam) 20 Texaschildrens.org ▷ Texas Children's Hospital. Webrate. (n.d.). Retrieved April 28, 2022, from https://webrate.org/index.php/site/texaschildrens.org/
- 21. Promising Drugs • Reduces apoptotic, inflammatory and oxidative brain injury. Erythropoietin • Antioxidant, antiapoptotic, cross BBB, neuroprotective Melatonin • Precursor of glutathione which is act as antioxidant N-Acetylcycteine (NAC) • Antioxidant, inhibitor of superoxide and hydrogen peroxide production Allopurinol 21 Nair, J., & Kumar, V. H. S. (2018, July 19). Current and emerging therapies in the management of hypoxic ischemic encephalopathy in neonates. Children (Basel, Switzerland). Retrieved April 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069156/
- 22. 22