NMH

NMH | 2024 265 Appendices 243 NMH ANNUAL REPORT | 2023 Appendices Circle findings for each domain PATIENT IS ELIGIBLE FOR COOLING WHEN 3 OR MORE DOMAINS HAVE FINDINGS IN COLUMNS 2 OR 3 Neurological Exam to evaluate candidacy for cooling: If in doubt as to whether patient qualifies for cooling, consult with the cooling centre promptly to discuss the patient. – 2 – Domain 1 2 3 Seizures None Seizures common: Seizures uncommon: (focal or multifocal seizures) (excluding decerebration) (Multifocal: clinical activity Or involving > one site which is asynchronous and usually migratory) Frequent seizures Note: If the patient is < 6 hours old and meets the gestation, weight and blood gas criteria and has a witnessed seizure, patient is eligible for cooling regardless of the rest of th is exam Level of Normal Lethargic Stuporous / Comatose Consciousness Decreased activity in an infant who is Demonstrates no spontaneous eye or aroused and responsive opening and is difficult to arouse with external stimuli Hyperalert Definition of Lethargic: • Sleeps excessively with occasional Definition of Stuporous: spontaneous eye opening • Aroused only with vigorous and • Responses are delayed but complete continuous stimulation • Threshold for eliciting such responses increased Definition of Comatose: • Can be irritable when disturbed • No eye opening or response to vigorous stimulation In both stupor and / or coma, the infant may respond to stimulation by grimacing / stereotyped withdrawal / decerebrate posture Spontaneous activity Active Less than active, not vigorous No activity whatsoever when awake or Vigorous, doesn't stay in one aroused position Posture Moving around and does not Distal flexion, complete extension Decerebrate with or without maintain only one position or "frog-legged" position stimulation (all extremities Term infants with HIE often exhibit extended) • Weakness in hip-shoulder distribution (eg proximal part of extremities) • Distal joints, fingers and toes often exhibit strong flexion • Thumbs strongly flexed and adducted. • Wrists often flexed • Above postures are enhanced by any stimulation Tone Normal Hypotonic or floppy, Completely flaccid like • Resists passive motion • Axial hypotonia (ie. head lag) a rag doll and/or limb hypotonia Hypertonic, jittery • Lowered threshold to all types of minimal stimuli eg light touch, sudden noises • Infant may even respond to his/her own sudden movements Primitive reflexes Suck: Suck: Suck: Vigorously sucks finger or ETT Weak Completely absent Moro: Moro: Moro: Normal: Limb extension followed by Incomplete Completely absent flexion with stimulus Autonomic system General Activation of General Activation of Sympathetic nervous system Parasympathetic nervous system Pupils: Pupils: Pupils: • Normal size (-1/3 of iris diameter) • Constricted (< 3mm estimated) • Skew gaze, fixed, dilated, • Reactive to Light • but reactive to light • not reactive to light Heart Rate: Heart Rate: Heart Rate: • Normal, > 100bpm • Bradycardia • Variable, inconsistent heart rate, (< 100bpm, variable up to 120) irregular, may be bradycardic Respirations: Respirations: Respirations: • Regular spontaneous • Periodic, irregular breathing effort • Completely apnoeic, requiring PPV breathing • Often have more copious secretions & / or ET intubation and ventilation and require frequent suctioning

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