Cause of neonatal brain injury in HIE?// Diagnosis: exam and labs
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- čas přidán 25. 07. 2024
- When does the neonatal brain lack Oxygen or Blood? Why does this cause HIE? What is its pathophysiology? How do we diagnose it? What are the important physical exam findings and blood work we would expect? This is part I of two videos on Hypoxic Ischemic Encephalopathy. (Part II will be on treatment or hypothermic therapy).
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What causes HIE? What are the stages? How do we perform a neurological exam for HIE patients? Learn all about the pathophysiology and diagnosis in part I of this series.
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Dr. Tala is a board-certified neonatologist, and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
Timecodes
0:00- Introduction
1:25- The pathophysiology of HIE
2:12- The Diving Seal Reflex
3:00- HIE and cell injury
4:22- The reperfusion injury stage
5:25- The diagnosis of HIE
6:12- Risk factors for HIE
7:06- What is considered significant resuscitation
7:42- Pertinent lab values
9:08- The blood gas: pH and base deficit
11:15- The physical exam
11:57- The neuro exam
13:53- The stages of HIE
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Power, B., McGinley, J., and Murphy, J. (2019). The modified sarnat score in the assessment of neonatal encephalopathy: A Quality improvement initiative. The Irish Medical Journal. Retrieved from www.semanticscholar.org/paper...
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Apgar scoring for newborn health assessment. (2021). American Baby and Child Law Centers. Retrieved from www.abclawcenters.com/practic...
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Worden, L.T. and Massey, S.L. (2020). Therapeutic hypothermia effects on brain development. Practical Neurology. Retrieved from practicalneurology.com/articl...
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Bhat, B.V. and Adhisivam, B. (2014). Therapeutic cooling for perinatal asphyxia-indian experience. Indian Journal of Pediatrics, 81 (6), 285-591. doi: 10.1007/s12098-014-1348-0
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Why babies with HIE may have multi-organ failure. (2017). American and Baby Child Law Centers. Retrieved from www.abclawcenters.com/blog/20...
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Apoptosis. (2021). National Human Genome Research Institute. Retrieved from www.genome.gov/genetics-gloss...
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Deorari. (2008). Blood gas analysis. Newborn WHOCC. Retrieved from www.newbornwhocc.org/pdf/Bloo...
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Coping with hypotonia. Speech Buddies. Retrieved from www.speechbuddy.com/blog/lang...
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Griff, A.M. (2018). Causes and treatment for dilated pupils. Medical News Today. Retrieved by www.medicalnewstoday.com/arti...
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
You are such an amazing lecturer! Love your videos so much! Thanks for making them :)
You are such a loyal viewer! Thank you so much for watching them and for continuing to give us positive feedback!
Dr. Tala, I have been a neonatologist working in the NICU for 30 years and enjoy your videos. Our field (neonatology) is beautiful. Thank you for your work. Peter Czech Rep.
Thank you- that means so much Dr. Janec- (assuming that is your last name!)coming from someone who has done this for so long. I feel like the longer I've done this the more humbled I am by what I don't know. But it is such a beautiful field- and it gives me so much happiness and satisfaction. Thank you so much for commenting and for watching any of these!
Father of a HIR baby, and now a nicu nurse where he was. Thanks for educating the world
Oh wow!!!! That’s so impressive- can’t imagine all the emotions you have gone through to arrive where you are! Congratulations on all of it!
Im an intern and i rotated in nicu 2 weeks ago and i wish i saw your channel then but im so happy catching up now! Thank you for your content! Much respect to you, doctor :)
Hello Dr. El Deita! We are so happy these are helpful for your NICU rotations and general pediatric information! Thanks so much for writing to us :)
This is such a great video! Thank you guys. Ready for part 2!! :)
Thanks Paxton! And thanks for your patience :)))
Another amazing video! Can’t wait for part II !
Thank you so much for your continued loyalty!! Part II will be next video we put out! Thanks :)
Thank you so much Dr. Tala! ! Your videos are my absolute favorite and such a wonderful resource while studying for my neonatal nurse practitioner exams and boards! Keep up the amazing work!
oh yay thanks Laura- so happy they're helpful. thank you so much for taking the time to write to us and for subscribing. WE wish you so much luck in your boards and your future career. XX
I am a resident in Pakistan and now rotating in NICU... You're videos are what i desperately needed.. thanks a lot doc .. always rise and shine and talk to us like this 😊😊
SO HAPPY!!! Thanks so much for letting us know and for subscribing. Your comment made us so happy :)
Neeem bhai iski jankari thoda Urdu me de skte hai
Another great video, look forward to the second part
So happy it helped Jo. We'll put out part II next :) Thank you for being here!
Great video, Dr. Tala! Looking forward to watching the cooling video next. I tell all my NICU colleagues about your videos :)
Oh thank you so much Karlie, for your support and for spreading the word. Comments like yours literally keep us going :)
Thanks Tala for your efforts and time we appreciate, your videos are really advisable for those who work in NICU ..💕
Thank you so much for watching and for giving us the positive feedback!
Excellent video ...
You explained everything so clearly thank you.
Assuming you're not remotely biased :) Thank you !!!!!!
I hear your all video it's amazing on way You are speaking clearly giving us lot of information
Thank you so much Nadar. So glad that you think the information is being delivered in a clear way. The biggest compliment! thanks!
really i love all your lecture . my respect to you , please continue shearing with us your knowledge
Thank you so much for your lovely message - we plan on continuing these videos for some time :)
Yessss , like before watching just like usual
Eagerly waiting to watch it once i returne to home😁😁
You're so sweet Sara- hope it lives up too expectations! Ha!
Thank you for such a clear video on the pathophysiology of HIE. Most sources only cover the aspect of how the brain is affected but my baby had acute renal failure and liver and gut issues as well.
Thankfully he has recovered amazingly well, probably in large part due to cooling therapy. I found your video as part of making sure I convey the details right because I plan to share his story. Thanks so much for putting this out there for everyone!
Hello Heidi- thanks so much for letting us know. I'm so glad your son has done amazingly well- cooling really has been absolutely life-changing. We hope you get to tell his story exactly as you want. XX
My son did very well after cooling. I am blessed that his brain is intact. Unfortunately he has had chronic constipation issues his whole life, and im convinced its related to his HIE. Of course none of his pediatricians believe me. Its so frustrating
You are amazing.. Please come with many more such videos
Thank you so much! We are working on it- we wish we could go faster but they take much longer than expected! Thank you :)
Loud and clear thank you ❤️
Excellent! Thanks is much :)
Tala, thanks for all your talks. They are incredibly thorough and helpful! I was wondering if you could make a video on High Frequency ventilation (HFOV vs HFJV)? Thanks!
Thanks for your positivity Nicole. We are planning an oscillator talk soon and then a jet one to follow...we got behind with requests but we promise we'll get there!!! Thanks again!
Been waiting for this❤️ and looking forward for part 2❤️
Hoping for Gastroschisis and Omphalocele on your upcoming videos☺️
Oh great Nurse Janice! So glad you watched it! We promise we'll be getting to the abdominal wall defects!!! Again, thank you for being here
You are an awesome teacher Dr.Tala.i pray i get to meet you someday,am inspired to be a neonatologist.
What a lovely thing to say! Thank you! It is a fantastic field- so we wish you lots of luck. It is also a small world neonatology- so there is a good chance we would run into each other eventually! Good luck!
Thank you 🌹, you have that special talent in clarifying and simplifying the subject.
Could you please make a video about neonatal sepsis?
Hello Amina! Thank you for the lovely compliment. We definitely need to do several talks on sepsis- which as you know we're all obsessed about in NICU. I think we've been shying away from it so far because it's a lot more dry facts rather than explanations. But obviously we need to do it soon!! Thank you so much for watching and for your request :)
😇Great voice. Great knowlege. Save the babies. Thank you Teacher
Thank you so much for watching and for commenting :) We're all about saving the babies :)
Thanks for teaching, very informative
Thanks so much for watching and for taking the time to send us a comment :)
This was very informative. Very impressive.
Thank you
So happy you found it informative! Thanks for taking the time to write to us :)
I am higher national diploma student in paediatrics in kenya ..this is a blessing
We're so glad these videos are helping you- thank you so much for letting us know :)
Nice clear video. Great teaching
Thank you so much, as always Sumathy!
This lecture made HIE extremely simple 😊
Thanks alot
So happy! Our goal is to make everything as simple as possible! Thanks for letting us know!
Thank you! Thank you! Thank you!
SO welcome! Thanks for being here :)
Thanks from India ...Very interested lecture 😎😎😎😎
We're so happy you found it interesting! Thanks so much Dr. Nabi!!
i am doing a course to become a qualified midwife. your videos are absolutely amazing, it makes everything so much clearer for me when i do my self-study sessions
Oh wow- thank you so much for letting us know. We're SO happy they're helpful. Good luck with your studies :)
Thank you so much! I enjoy your videos.
Please could you do one on cranial ultrasound pointing out the structures in coronal and Sagitta views and significance of findings in common neonatal conditions e.g HIE, stroke, GMH/IVH, RI, VI, etc. thank you!
This is a great idea for a video! Going over basic structures is a good idea and some common abnormalities we see. Many diseases have subtle changes and I’m not a radiologist (let alone a neuroradiologist) so maybe will be covering the basics! Thank you!!!
Short and crisp 👌
That's what we're aiming for!!! Thanks so much Dr. Umang :)
Thank you Dr now I understood HIE
Well, that's just great. Thanks so much for being here!
thanks for the nice explanation..
Thank you so much Kumar, for watching and commenting!
Thank you very much Dr.you help me understand my child in which stage he is.
I’m sorry you’re going through this/ wishing your family health xx
Absolutely amazing teaching mam
Thank you so much! What a lovely comment!
Hi Dr Tala, ur video's helping us alot to learn, plz do a vedio on NEC and awaiting the next part of ventilator vedio
Hello Merin- thanks so much. NEC will be coming soon- we'll have two episodes and then we'll need to film a few more on the ventilator (high frequency and different modes etc.). It takes us a lot longer to film these and edit etc. than we had initially planned, so we need to ask for your patience!!! Thanks so much!!
Thanks amazing and great
Thanks so much Azam, for continuing to watch and for continuing the positive reinforcement! We're appreciative!
You’re God sent
We're so happyy you're finding these videos helpful. Thank you for the lovely sentiment!
CFM and ABP please. your videos are very helpful.
Hello! Joana! CFM is a great idea! Will need to figure out how to do that without any copyright issues. Not sure what ABP acronym is though! (Presumably not American Board of Pediatrics?- did you want us to cover the neonatal stuff on the Peds boards?) Let us know!!! Thanks for watching!!!
Excellent dr.Tala
Thank you so much!
Excellent video🙂🙂
Thank you so much for watching and commenting!
Thanks
Welcome
Please make more educational video like this 😍
We're working on it Mira! They take time- but lovely comments like yours keep us going :)
Waiting part 2👌👌
Soon! Thanks for continuing to watch Dr. Nirwal :)
Excellent. Very clearly explained as always.
I have some questions in the pathophysiology of HIE for a long time..
Q. What exactly is the cause of excitotoxicity which is present in all the 3 stages i. e primary energy failure, latent phase, sec failure
Q. Why there is inflammation in latent and sec energy failure stage.. As we learnt in pathology apoptosis is not associated with inflammation
Hello Salman! These are excellent questions. I am by no means an expert in this but I will try to answer your questions and then refer you to the most cited paper on the pathophysiology.
Essentially it is thought it is reperfusion that sets up all the excitotoxic pathways (what the exact trigger is, I'm not sure).
Apoptosis is not necessarily triggered by inflammation, but they can coincide when a tissue is injured. This also happens in NEC.
You will do much better to look through basic science papers- starting with this one: www.nature.com/articles/pr19972030
Thank you so much, as always for being here :)
@@TalaTalksNICU thank yoi
ما شاء اللة. بارك اللة فيكم.
You are a fantastic supporter :)
Great one, would you be doing a video on neonatal seizures?
Yes Nirmala! That is a great suggestion- we're just trying to figure out how best to show the different seizures without copyright issues etc.! Thanks for watching and for your great suggestion!
Very educative
Thanks so much for watching xx
thank you!)
Thank you so much for watching :)
Would be awesome if you could do a video on amplitude EEGs and how to interpret them
YES! This would be a great video- I will try to get in contact with a company that has aEEGs. Always a good revision for me too- thank you for the great suggestion!
My daughter is a HIE patient for last 16 months.At her age of 8 she had fever and cardiac arrest and seizures.Now she has her senses back but still bedridden
I’m so sorry- what a tough tough situation. I hope for her continual improvement
Really enjoyed this video right to the core....can you please also do a video on Cerebral Palsy (CP). Thanks
Hello! So glad this helped! Honestly CARLOVER CP obviously has its basis when babies are just born but it’s not a diagnosis that is usually made until kids are older. So I don’t feel like I’m the right person to talk about this!! We will try to find someone who has a lot more experience!
@@TalaTalksNICU Thank you very much for your feedback. Really Appreciated .
In time you wrote that a friend of mine who is a developmental specialist agreed to do it :)))
@@TalaTalksNICU I'm really humbled by your input @NICU Tala Talks. Thank you once again ❤
Should i substrac RPC volume(not whole blood),FFP, CRYO. platelets .iv albumin from the total iv fluid. Tank you
Great question! obviously if you're giving loads of blood products you want to take into account the extra volume- we just don't necessarily subtract it exactly. (As in drop your fluids to ~50ml/kg/day and make sure GIR is sufficient). Maybe different groups practice differently though!
Will you please make a video about the physical exam and common clinical signs of prem babies?
Yes! We've actually filmed a whole series- and we just need to go through the editing- so we're hoping we'll be releasing them all soon!!! Got behind a bit!! Thanks so much for subscribing Beatrix :)
It's so nice to understand your talk. But please let me know if HIE can be congenital and what are the symptoms of congenital. What are the methods to know since when the expectant mother was carrying the condition?
When we talk of HIE- we are talking about events at time of birth which cause it. So yes 'congenital' as in born with it- but generally from lacking oxygen/ blood during labour/ delivery. Does thus help?
@@TalaTalksNICU thankyou so much for the information. Actually my daughter is no more. She lived only for 76 days.When she was taken to doc on her last day, reason was cyanosis, hardly she was able to breath. My Doctor said it was congenital whereas some other doctors for further treatment when consulted told that it was during birth. She was given medicine for seizures 'levetiracetam'.
@@TalaTalksNICU It was after 1 month when she bitterly cries and suddenly left Suckling , I came to know that she has HIE which was clear with MRI. She had unusual movements concluded as seizures. She had extreme nasal congestion.
Oh I'm so sorry- I just saw this. How tragic. I'm so so sorry for your tragic loss.
Dr. Tala in which month should brain mri of new born baby be done so that it can be known how much injury has been done in Brian?
Generally when we cool babies in the unit we get an MRI. Although honestly- I'm not sure how much this adds- maybe a little to the prognosis. The physical exam seems to be a lot more telling!
Thanks for a brilliant talk Dr Tala. I came across you from Dr Sridhar's channel and I'm really enjoying learning from you both.
Regarding the Sarnat staging, what's the optimal timing for the test to be done, because Especially in stage I babies, we see them quite stunned to begin with, but the neurological examination tends to improve with time. So what's the best time to do the staging examination? Thanks in anticipation, Dr Bharat, Ghaziabad, India.
oh this is SUCH a good question and one we all talk about all the time at bedside. For me- if at 1 hour the baby has a bad enough neurological exam (i.e. Sarnat II and above) and has the history/ lab data to support it, I will cool. As I've gone further in my career I've been more afraid about missing a baby that needs cooling and then they have a seizure and it's too late. Also- we know from animal and human studies that the sooner we start the cooling the more helpful it is. The intial studies were making those decisions by about an hour. I also discuss this extensively with parents before making the decision.
The other side of the argument is that if the labs/ history is borderline- then we should be doing serial hourly exams and making the decision by 6 hrs. I have colleagues who (appropriately) do this. There's also lots of missing data on cooling for stage 1 babies- is it dangerous? Make them better?
I will say- if there is a premie baby- e.g. 35-36 weeker- I'm more likely to follow the exam for a couple of hours. These babies don't tolerate cooling as well.
Sorry- probably not very helpful. A great example of how we all follow literature sometimes differently.
@@TalaTalksNICU A great reply! Thank you for your time and the wonderful work you're doing. Best regards and good wishes, prayers.
Thank you so much for being here and for making our community stronger :)
Hey Tala I believe I was born with HIE. My mother was in 3 days of labor with me and when my heart rate started to fall because of inadequate oxygen I believe I was asphyxiated. My mother remembers
the doctor was negligent, slow, and nervous to perform the c-section. It seems I was very unlucky. I suffer from cognitive impairments that deal with attention, processing, working memory, and short term memory. Anyways my question can doctors/neurologists identify damage that was done during labor on adults like myself (I’m 28 now) from HIE?
Hello Henok! I'm so sorry you're having cognitive issues. it's possible an MRI done now could show some ischemic changes, but it would be almost impossible to prove that they were caused at birth. I really hope you find the help, support, and tools you need to live as happily as possible .
Dear Dr. Tala, thank you for your video. It gave me a great lesson for understanding HIE. I read a paper regarding MRI & MRS in order to measure a brain damage with neonatal with HIE. However, it doesn't describe when this MRI or MRS is performed for babies. If neonates are confrimed having HIE using either physical exam or neuro exam, when is the asssessment of Brain damage performed? Is it performed after the neonates' conditions are stable or is it performed besides the physical exam or the neuro exam?
Hello! Thanks so much for watching and for subscribing :)
Generally we wait 1-2 weeks before doing the MRI (after the baby is stablished. Personally I prefer to do the MRI when infant extubated/ preferably without central lines- because easier to get an MRI at that point). Other hospitals have other protocols. If you want MRI with spectroscopy (i.e. measuring lactate levels etc), then MRI should be done during acute injury. Findings on an MRI are not used to make a decision about cooling. They are really just used for prognosis- which honestly -they're not great at doing! Physical exam is way more important!!
@@TalaTalksNICU Thank you for your response.
What is the current protocol for neonats with nurological encephalopathy where monitoring brain temp is called for.
We usually monitor with aEEG during cooling therapy and then we get a MRI and a proper EEG afterwards. Does this answer your question?
Can i ask aquestion if baby was born obstructed labour ph cord 6.8 need ambu for only 30 seconds good apgar at 5 minutes neurological exam hypertonia candidate for cooling or not
It would really depend on the rest of the neurological exam. Generally hypertonia is associated with other muscular or neurological issues, or CP, so more history would also be needed (i.e. not generally because of acute hypoxia, and if it is, then most likely mild HIE). Honestly, were often in this type of situation with cooling- infant doesn't fall quite into any category, so we have to make a decision based on best facts.
Hi doctor
My nephew suffered hie during a surgery of removing a plate from his leg. He was 3 years old at that time. And now he is suffering from its effects. And its been 4 years. Is there any way to improve his health apart from occupational therapy. Will cooling therapy help him now. Please help us
Hello- I’m so sorry about your nephew. Cooling has to be done within 6 hours of the injury for neonates. I don’t know about any of the data in older kids but it has to be done very soon after the injury. I hope that OT and therapy helps and he continues to improve
👏🏻👏🏻👏🏻👏🏻🙏🏻
Thank you Havva! We’re happy you’re continuing to watch our videos :)
Hi Dr..
Regarding my one-month-old baby, a VBG (vascular blood gas) test was performed, which showed the following results: cord blood pH 6.9, pCO2 59.3, HCO3 14.8, BE 17.8, and lactate 11.2. The central nervous system (CNS) examination revealed that the baby is alert, active, conscious, and moving all four limbs equally, with no focal deficit or no abnormal movements noted. Additionally, the Apgar scores were 7 at five minute and 9 at ten minutes. The baby has not experienced any seizures, and no dysmorphic features or no neurocutaneous markers have been observed. Please clarify whether my baby can be considered as having mild hypoxic-ischemic encephalopathy (HIE) or not."
hello- if the baby is neurologically completely normal (in first few hours after birth)- then we can't make an argument baby has any HIE. (Neuro exam of mild HIE is hyperactive state- high HR, infant agitated etc.).
Can moderate HIE cause autism in a newborn? My child took right over 2 hours to get out from the last phase of birth (pushing phase). My child also had trouble getting completely out and got stuck with his head outside while having the umbilical cord around his neck and his leg. The umbilical cord was also short. When we got him on the mothers chest he was blue and very calm, no sound or anything from him. I am afraid that he got lack of oxygen/blood to his brain in the last phase of birth which caused autism or brain damage some sort off. How can we find out if it is a delivering mistake of the birth at the hospital or if it is autism genetically?
Hello- we are so sorry you are going through this. There is so much unknown about autism. A couple of studies have suggested that the risk of autism is slightly increased in infants who suffered through a parietal depression. We hope you find the answers and peace you are looking for.
Hi @mirakel2k . Yesterday I have delivered baby who exactly came out like yours. I’m freaking out with this kind of situation and don’t understand what happening further . Please let me know how you overcome with this kind of situation
@@bhargavitalari1482 Hi Bhargavi, hope your baby is good and safe. im too facing the same situation right now. can you please share your baby health situation as of now, does he/she faces any side effects?
My father had accident 3months ago.he was in icu for 1month. Now dr.said he had hie. Focal cortical atrophy in right frontal area. Can he recover?? Pls mam answer me.
We are so sorry about your father's accident. Unfortunately we can't really comment on adult brains as they are so different in injury and healing than neonatal brains. We wish you much luck and health.
Large bilateral symmetrical areas of cystic encephlomalacic changes are seen in cerebellar hemisphere with prominent 3d and both lateral ventricles with diffuse atrophy of corpus callosum. is there any treatment for this
How is the baby otherwise? Breathing? Sucking? Not sure about current neurological status. A lot of time in the brain there is no cure. But even though there is no treatment- it is unbelievable how much patients can improve with therapies and with being pushed. The growing brain is constantly making new pathways and so in a baby who is well enough to survive (breathing, ability to eat etc) the outcomes are often better than we’d guess. I’m so sorry
Mom please tell me some medicine, my leg is getting tight
@@TalaTalksNICU white matter big problem
Hi do you know if someone is affected by mild learning disabilities due to hie will these issuses usually pass to their child or no?
Usually no Sarah- as a learning difficulty from HIE would be something that 'happened' to the mother, not something she's necessarily genetically carrying. But! What a complicated question! How can we be sure the learning disability is definitely due to HIE rather than something else (4% of term kids have them). Also if a mother were in a situation that she weren't able to engage fully with her child then that would affect the child's development. (Studies show that the more words a baby is exposed to in the first three years of life can really affect them). So in summary- probably not, but I don't know!!!
@@TalaTalksNICU I knew it was abit of a who knows type of question.Good answer though.thank you!
My son suffering HIE please suggest dr.
We're so sorry. We wish him health and strength XX
How can i prevent HIE to happen to any other newborn if i have history?Can erective CS be of help ?
Hello Flower- congratulations on your pregnancy. We're sorry you had difficulties with the first. This is really a question for your OB- a smooth delivery without the infant being 'stressed' is the way to prevent most cases of PPHN. Good luck!
Hi mam my wife got cord compression during her pregnancy @37 th week planned for c section baby was born without heart beat loose muscle tone after 20 min struggle baby got heart rate and then had hypothermia treatment doctor said HIE problem MRI scan is normal nd EEG was slightly disturbed...is there any problem for brain development...my baby was 45 days old shes sucking movement eye sight crying all or ok mam but head size is decreasing is there any problem mam brain development???
Dear Vetri- we're so sorry you have had such a difficult time. That the MRI was normal is encouraging. Ultimately though the only true predictor of development is time. We hope you are getting the help you need. We send you luck.
Dear Ma'am, I am from India my baby boy is HIE and he is 1 year 3 months old. he is not holding neck properly and not siting. He is see and hearing properly, what we can do now please suggest me.
Hello- we're so sorry you are struggling through this. Obviously we don't know anything about your little boy, but it sounds like he could benefit from physical and occupational therapy. Go through your pediatrician to evaluate which services may be available for him. Good luck
@@TalaTalksNICU Ma'am ,Thank you so much for your reply my comment, we are already started occupational therapy hope we will recovered soon emotional and psychological trauma.
What happens if they did lose fetal heart rate for about 15 minutes, then the baby was born with chord also around his neck and an apgar score of 6. He was blue at birth and floppy. And now the baby has low muscle tone since birth, but the neonatal team never assessed for HIE or further lab work. Would they have missed?
HIE is very much a clinical diagnosis- dependent on Apgars, gases, physical exam and history. (An apgar of 6 at 1 and 5 minutes is pretty good!) I'm guessing there was ongoing assessment by the team. I hope the baby continues to heal and improve!
I am resident in Malaysia my baby was affected in hie stage2.. Can my baby recovery?
Hello- I’m sorry your baby and you went through this. It is almost impossible to predict outcomes based on the stage alone (like we can’t predict the outcomes of babies without HIE). It depends on many factors- including how your baby is doing now. We wish you luck and health xx
Dr. Tala, can you tell me whether brain injury can be cured in a new born baby?
It really depends on the extent of the injury and what you mean by cured! The brain is absolutely crazy and creating alternative tracts if something goes wrong- so it is much better at fixing injuries than we ever thought it was
Large bilateral symmetrical areas of cystic encephlomalacic changes are seen in cerebellar hemisphere with prominent 3d and both lateral ventricles with diffuse atrophy of corpus callosum.
Is respiratory acidosis (PH: 6.96 and PCO2: 112 mmHg- BUT no BE result)- cord blood gases- consider a marker of HIE? 🙏
Great question. The baby isn’t breathing- all c02 needs to go to the placenta. So if the c02 is elevated this still implies a problem with getting blood circulating. So yes - normally we look at base- but that’s why in this scenario- pH is important.
(And here I’m assuming this is a cord gas). If this is the baby’s gas then this is respiratory acidosis!
@@TalaTalksNICU Yes, Respiratory acidosis. actually, why I’m asking that coz the baby’s Apgar scores were 4, 4 and 6. His Oxygenation (including his BP) stayed within normal range since delivery and during NICU admission.
So, do I have to deal with him as HIE (PH is low, but RA, and obvious low Apgar score) and start therapeutic hypothermia?. 🙏
@meeromeer8812 not if it’s the baby’s gas. Sorry thought this was cord gas. Obviously I don’t have full picture so I don’t know about cooling- but from that gas baby has significant respiratory component
@@TalaTalksNICU it is the cord gas!
Hello Dr I'm having one year old baby he was born with HIE..
Hello! Hope your one year old is doing well now :)
Which part of the brain is the most affected in HIE Dr. Tala ?
White matter injury is the predominant HIE type injury- but depending on how bad the hit was- can be all parts of brain.
@@TalaTalksNICU Thanks a lot Dr/ Tala :) :)🙏🏻
we need resuscitation videos please
Hello Omar! You're right- this is sooo important- we are trying to figure out how to do this without upsetting (or really infringing on the copyright!) of NRP. We will figure it out!!! Thank you so much for being here!
@@TalaTalksNICU where should go for treatment
My baby is 4 year old
And he is hie
Wish I was here for professional reasons like everyone else in the comments :(
I’m so sorry- wishing you all health and peace and the best outcome possible xxx
❤❤❤❤❤❤❤❤❤❤♥♥♥♥♥♥♥♥♥♥♥♥♥♥
Love this comment!!!!!! Thank you!
You should NOT cool a baby with seizures?
If a patient develops seizures from HIE then by definition the baby had moderate HIE and likely would have benefited from cooling. The problem is seizures from HIE usually develop 12-24 hrs later and the decision to cool should happen within the first 6 hrs of life. Does that make sense?
Thank you for your reply. That makes sense perfectly.
How would you handle a baby that had a seizure at less than 6 hours of life?
Would it be assumed the injury/event occurred well before delivery outside a 6 hour window and also not trigger cooling?