Hypoxic-Ischemic Encefalopathy Management in an Ultra Peripheral Hospital

Hypoxic-ischemic encefalopathy (HIE) due to birth asphyxia occurs when there is an acute hypoxic-ischemic event that causes various sings and symptoms. The treatment of choice for this condition is therapeutic hypothermia, accompanied by supportive management. It has been available in Portugal since 2009 and currently there are 4 hypothemia centres.

This restrospective study intends to characterize the patients with this pathology (HIE) in an ultra peripheral hospital. Since this hospital doesn’t have the ability to treat with induced hypothermia, our eligible newborns were transferred to a central hypothermia centre. Clinical charts from 2011 to 2018 were analysed.

The first patient submitted to hypothermia was in 2012. Of the newborns admitted to this Neonatology unit, 17 were diagnosed with HIE, 47% were male. 8 were transferred while 9 remained and received supportive management. From the newborns submitted to hypothermia treatment, 2 developed Cerebral Palsy (CP) while the rest are considered to have a normal psychomotor development. In the group that remained, 3 developed CP. 82% of patients with HIE suffered acute fetal distress, being late decelerations and sustained bradycardia the most common causes. 82% had neonatal seizures and were treated with phenobarbital. Head MRI or aEEG are not available, to the pediatric population, at our hospital, making it difficult to assess severity which may lead to unnecessary transfers. Risk factors were present in some patients: 1 uterine rupture; 1 cord prolapse and 1 case of HIE due to Fetomaternal Transfusion.

This study intends to demonstrate how important it is to be able to diagnose this condition early to arrange tranportation that isn’t always available in the small window we have to start treatment.