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46 Neonatal Encephalopa y 2020 | NMH Annual Rep t 2021 | NMH Annual Rep t S ince 2013, NMH now reports on all infants ≥35 weeks gestation who during the first week of life have: • Either seizures alone or • Signs of Neonatal Encephalopathy which is defined as clinical findings in 3 or more of the following domains: • Level of consciousness • Spontaneous activity when awake or aroused • Posture • Tone • Primitive reflexes • Automonic system For a more detailed description of the findings in each domain, please refer to appendix 5. To be included in our annual figures, the signs of neonatal encephalopathy (whether mild, moderate or severe) must be present for at least 24 hrs. Cases reported are reviewed and some are subsequently reclassified as Hypoxic-Ischaemic Encephalopathy if there is clinical evidence of encephalopathy (as defined above) associated with one or more of the following physiological criteria: • Apgar score ≤5 at 10 mins of age • Continued need for resuscitation (endotracheal intubation or PPV) at 10 mins after birth. • Acidosis within 60 mins of birth (defined as a pH < 7.0 in an umbilical cord or any neonatal arterial, venous or capillary blood sample) • Base deficit ≥ 16 mmol/L in an umbilical cord or any neonatal blood sample (arterial, venous or capillary) within 60 mins of birth Reference is also made to which cases undergo therapeutic hypothermia. Please note that the physiological criteria which are now used to reclassify a case as HIE are broader than the criteria applied in previous years. If pertinent obstetric details surrounding the delivery are not available to us (as in the case of outborn infants) to allow a case to be catergorised as HIE according to the above definition, then, the case, by default, is reported as a case of Neonatal Encephalopathy. In all reported cases, it is assumed that there is no evidence of an infectious cause, a congenital malformation of the brain or an inborn error of metabolism that could explain the encephalopathy. All cases (both neonatal encephalopathy cases and hypoxic-ischaemic encephalopathy cases) are further categorised according to severity of presentation. The most severe stage observed during the first 7 days following birth is recorded based on the infant's level of consciousness and response to arousal manoeuvres such as persistent gentle shaking, shining a light or ringing of a bell. Infants are considered to fall into the 'mild' category if they are alert or hyperalert with either a normal or exaggerated response to arousal, infants fall into the 'moderate' category if they are arousable but are lethargic and have a diminished response to arousal manoeuvres and infants fall into the 'severe' category if they are stuporous or comatosed and are difficult to arouse or are not arousable. If further clarification regarding any of these clinical terms or definitions is required, please refer to appendix 5. Since 2017, infants who have seizures but who are not clinically encephalopathic are no longer included in the neonatal encephalopathy figures as before; they will now be listed separately. Neonatal Encephalopa y 2020 | NMH Annual Rep t