Hypoxic Ischemic Encephalopathy: Pathophysiology and Experimental Treatments
Section snippets
Pathophysiology of HIE
Hypoxic ischemic encephalopathy is a disorder in which clinical manifestations indicate brain dysfunction.3 Although the exact cause is not always identified,10 antecedents include cord prolapse, uterine rupture, abruptio placentae, placenta previa, maternal hypotension, breech presentation, or shoulder dystonia.8, 12 The manifestations of perinatal HIE include abnormal fetal heart rate tracings, poor umbilical cord gases (pH <7.0 or base deficit ≥12 mmol/L),13 low Apgar scores,14 presence of
Neuroprotective Agents to Manage HIE
The uses of neuroprotective agents for primary energy failure being explored are limited to preconditioning the cerebral tissue to require low levels of oxygen before the hypoxic-ischemic event.34, 35, 36, 37, 38 At this point, preconditioning of cerebral tissue is not well understood and is not feasible in humans. Most emerging treatments to ameliorate the effects of secondary energy failure in HIE target one of more of the following areas: decreasing energy depletion, inhibiting glutamate
Conclusion
Hypoxic ischemic encephalopathy is one of the most serious birth complications affecting full-term infants1 with few preventive treatment modalities available.9 The hypoxic-ischemic event can be caused by multiple events, but ultimately, brain injury occurs because of impaired cerebral blood flow17 and oxygen delivery to the brain.15 The phases of injury are categorized as primary and secondary energy failures, with the latent period between the phases being the optimal timing for interventions.
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The preparation of this article was partially supported by 1F31 NR012083-01 from the National Institute for Nursing Research, NIH to the first author.