The hypoxic encephalopathy, also called hypoxic ischemic encephalopathy or cerebral hypoxia, it appears when the amount of oxygen reaching the brain is reduced or interrupted, causing brain damage.
This occurs because the nervous system needs a continuous supply of oxygen to function properly, and if it is absent for a long time, the nerve cells are injured and can die..
The term "encephalopathy" refers to a dysfunction or disease of the brain, that is, a condition in which brain functions are altered and deteriorated. On the other hand, "hypoxic" means lack of oxygen. While "ischemic", a term that often appears in this condition, is associated with a restriction of blood flow to the brain and other important vital organs.
This can happen in a variety of ways before, during, or after birth; and even throughout childhood. It usually leads to severe developmental or cognitive delays, as well as motor deficits, which become more noticeable as the child grows.
There are two distinct stages in the acquired injury in hypoxic ischemic encephalopathy. In the first, there is oxygen deprivation itself.
While, in the second, the so-called "reperfusion damage" occurs. It happens when the circulation of oxygenated blood to the brain is suddenly reestablished, causing adverse effects. It is because the restoration of blood flow can be linked to the accumulation of toxins, free radicals, calcium, alterations in cell metabolism, etc. What can cause damage to the body.
Despite important advances in the management and understanding of fetal and neonatal problems, hypoxic-ischemic encephalopathy continues to be a serious disease and can lead to significant damage and even death..
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According to Ferriero (2004), asphyxia during birth causes 23% of neonatal deaths worldwide. It appears to be more common in countries with limited resources, although the exact figures are not known.
The World Health Organization considers hypoxic encephalopathy as one of the 20 main causes of the burden of disease (with higher morbidity and mortality) at all ages. In addition to being the fifth leading cause of death in children under 5 years of age (8%).
Children who survive this condition can develop problems such as cerebral palsy, mental retardation, learning difficulties, etc..
First of all, it is necessary to clarify that asphyxia is not the same as hypoxic-ischemic encephalopathy. The first will be a cause, while the second is the effect, and suffocation will not necessarily cause a brain injury.
Hypoxic encephalopathy is caused mainly by the suffocation of the baby. The events that can lead to it are associated with characteristics of the mother, the baby, defects in the placenta or complications at birth.
That is why the causes are very diverse. Only a few of them are mentioned here:
- Acute hypotension of the mother.
- Maternal diabetes accompanied by vascular problems.
- Poor blood circulation to the placenta.
- Preeclampsia or toxemia of pregnancy, a dangerous condition in which there is hypertension, high levels of protein in the urine, edema, and weight gain in pregnancy.
- Blood clotting disorders in the mother, which can cause bleeding.
- Acute anemia in the fetus (causing disturbances in adequate oxygen transport).
- Intense pressure on the baby's skull.
- Umbilical cord knots around the fetus.
- Umbilical cord prolapse.
- Uterine or placental rupture.
- Lung malformations of the baby.
- Abnormal fetal position during labor.
- Drug and alcohol abuse during pregnancy.
- Medical negligence.
After birth, some of the risk factors for hypoxic ischemic encephalopathy in babies include:
- Severe heart or respiratory disease.
- Low blood pressure.
- Being born prematurely.
- Infections such as meningitis.
- Brain and / or head trauma.
- Congenital malformations of the head.
Depending on when the suffocation occurs and the severity of it, it can harm one area or another of the brain.
It appears that if the injury occurs before week 35 during fetal development, periventricular leukomalacia is common. It is a type of injury that affects tiny areas of the white matter around the brain ventricles.
If it occurs at 40 weeks, the degree of hypoxia influences the affected areas. If it is mild, it damages the parasagittal white matter, while in severe forms the paracentral white matter, the putamen, and the thalamus are damaged..
According to the injured brain areas, the baby will manifest different symptoms.
The signs and symptoms of hypoxic encephalopathy vary depending on the severity of this condition..
It can be identified by symptoms such as:
- Muscle tone somewhat higher than necessary.
- Deep tendon reflexes, such as the one that occurs when the patellar tendon is struck, appear energetic for the first few days.
- Behavior disturbances such as poor appetite, irritability, excessive crying, and drowsiness.
- These symptoms usually disappear within 24 hours.
- Decreased deep tendon reflexes and low muscle tone.
- Newborn primitive reflexes, such as grasping or palmar pressure, mooring, and sucking reflexes may be slow or absent.
- Occasional periods of apnea or breathing pauses that are out of the ordinary.
- Within 24 hours after birth, seizures may appear. These are usually associated with altered electrical brain activity.
- In many cases, a full recovery occurs in about a week or two. This is linked to a better long-term prognosis..
The most severe cases are manifested by generalized seizures, more intense and resistant to treatment. They are more frequent during the 24-48 hours after their appearance, coinciding with the reperfusion injury mentioned above..
As the injury progresses, the seizures disappear while the waking patterns deteriorate so that the baby appears lethargic.
In addition, there is a prominent fontanelle. The fontanelle is an area on the top of the baby's head that is soft since the bones of the skull have not yet joined. In this case, it stands out as a sign that cerebral edema (accumulation of fluid in the brain) is developing..
This condition can cause brain damage to a greater or lesser extent, which is manifested in behavior more and more clearly. Generally, the severity of the damage cannot be determined exactly until the child is 3 or 4 years old..
The main long-term consequences of hypoxic encephalopathy are:
- Poor neurological development
- Motor problems
- Cognitive impairment
- Epilepsy
- Cerebral palsy, although it is a less frequent complication than previously thought. It appears that only 9% of cerebral palsy cases are a direct result of suffocation. It is actually more likely due to premature birth, complications during or immediately after delivery.
The intervention should be done as soon as possible in a case of hypoxic encephalopathy. First, mechanical ventilation is often used to help the baby breathe properly..
A technique called therapeutic hypothermia has been shown to reduce death and disability in many of these cases. To do this, localized cooling is carried out on the baby's head or throughout the body, with the aim of reversing the hypoxia caused by high temperatures..
If the newborn has carbon monoxide poisoning, hyperbaric oxygen treatment is recommended..
Other factors are also controlled so that the damage does not continue to advance, so that an attempt is made to maintain normal blood glucose, as well as the amount of acid, keep blood pressure at bay, treat seizures with anesthesia and medications, etc..
In the case in which other organs have been injured, the specialists will try to establish treatments, reducing the symptoms as much as possible and increasing the functionality.
If brain damage has already occurred, these patients need to require neuropsychological, physiotherapeutic and occupational intervention in the future.
Since injuries have occurred at a young age and the infant brain is characterized by significant plasticity, there are many cognitive and motor aspects that can be improved.
The best way to prevent it is, obviously, to eliminate the suffocation of the baby during pregnancy and delivery; since it is the main cause. That is why it is recommended that all possible care be followed during pregnancy and delivery, such as:
- Monitor the status of the fetus during pregnancy and delivery through fetal monitoring, a non-invasive technique that uses a cardiotocograph. This device reflects on a screen the number, intensity and duration of contractions, as well as the heart rate of the fetus.
- Make sure that doctors are specialized and properly qualified to supervise the entire process of pregnancy and delivery.
- In the case of pregnancy, monitor the state of health strictly and have periodic medical check-ups. Follow all the recommendations and treatments indicated by the doctor.
- Do not take any drug without consulting your doctor. In addition to restricting drug, alcohol, or caffeine use.
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