Hypoxic-ischemic encephalopathy

Hypoxic-ischemic encephalopathy (HIE) in neonates is often difficult to diagnose in “real time” at the bedside because of the variety of disorders that can cause neonatal seizures and other nonspecific signs of encephalopathy. Standard interventions to support respiratory and cardiovascular disorders associated with HIE are appropriate, but none has been demonstrated to alter neurologic outcome. Anticonvulsants are indicated when seizures are observed, although they are considered a sign of HIE rather than a cause of injury. There is overwhelming evidence that the excitotoxic cascade that evolves during HIE extends over several days after the insult and is modifiable. Clinical trials of potentially neuroprotective interventions such as hypothermia are under way.