NMH

NMH | 2024 70 Neonatal Encephalopathy Since 2013, NMH now reports on all infants ≥35 weeks gestation who during the first week of life have: • Signs of Neonatal Encephalopathy (NE) which are defined as clinical findings in 3 or more of the following domains, present for at least 24 hrs: • Seizures • Level of consciousness • Spontaneous activity when awake or aroused • Posture • Tone • Primitive reflexes • Automonic system or • Seizures alone All NE and seizure cases are reviewed and classified as as Hypoxic-lschaemic Encephalopathy (HIE) based on the presence 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. Hypoxic Ischaemic Encephalopathy, Neonatal Encephalopathy & Seizures • 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 Reported cases are therefore classified into one of 6 groups: · HIE inborn · HIE outborn · NE without HIE inborn · NE without HIE outborn · Isolated seizure without NE or HIE inborn · Isolated seizures without NE or HIE outborn Reference is also made to which cases undergo therapeutic hypothermia. If pertinent obstetric details surrounding the delivery are not available (as in the case of some outborn infants), then, the case, by default is reported as a case of Neonatal Encephalopathy without HIE. In all reported cases, it is assumed that there is no evidence of an infectious cause, 35 30 25 20 15 10 5 0 Infants Undergoing Therapeutic Hypothermia in the NMH 2020-2024 Total Inborn 2023 2020 2021 2022 2023 2024 Inborn 8 6 7 4 9 Total 13 11 14 7 21 2022 2021 2020 2024 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 the appendix.

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