Neonatal Encephalopathy

Abstract

Historically, hypoxic-ischemic encephalopathy (HIE) has been used to describe any infant who is encephalopathic following birth. This terminology, however, infers etiology (hypoxia and ischemia). There is now substantial evidence demonstrating that HIE accounts for only a portion of infants presenting with neonatal encephalopathy and only accounts for 4% of the diagnosis of cerebral palsy (Badawi et al., BMJ 317:1549-1553, 1998). Confusion over terminology has significant implications medically, developmentally, psychologically, and medicolegally. As a result, the American College of Obstetricians and Gynecologists (ACOG), in collaboration with the American Academy of Pediatrics (AAP), has issued a report clarifying the preferred term to be neonatal encephalopathy (NE) (Obstetrics and Gynecology 123:896-901, 2014). This descriptive term describes the presentation without ascribing etiology, which may take months to determine. This chapter will focus on the terminology of NE, pathophysiology as it relates to the aspect of hypoxic ischemia, and the relationship to current management protocols. It will also discuss the evidence around outcomes and associated challenges with its interpretation.