Synopsis
Recognise neonatal encephalopathy after perinatal compromise, stabilise physiology, determine therapeutic-hypothermia eligibility within 6 hours, monitor seizures and multiorgan injury, and communicate prognosis using serial multimodal assessment.
- Neonatal encephalopathy is abnormal neurological function; HIE is the subset attributable to impaired oxygen delivery and perfusion around birth after alternative causes are considered.
- Assess biological evidence of perinatal compromise and neurological evidence of moderate or severe encephalopathy; neither an isolated low pH nor a difficult birth alone proves HIE.
- Stabilise effective ventilation, oxygenation and circulation while avoiding hyperoxia, hypocarbia, hyperthermia, hypoglycaemia, marked hyperglycaemia and hypotension.
Key red flags
Apgar score 5 or lower at 10 minutes, ventilation still needed at 10 minutes, severe early acidosis or a documented acute perinatal event triggers urgent encephalopathy assessment.
Investigation priorities
Document biological evidence of impaired gas exchange and track perfusion recovery.
Detect, quantify and guide treatment of neonatal seizures and assess background recovery.
Management branches
Perinatal compromise is followed by abnormal neurological function.
- Stabilise physiology, avoid hyperthermia and gather cord gas, early gas, Apgar and resuscitation data.
- Grade encephalopathy and start aEEG/EEG; contact the regional cooling centre immediately.
The baby is physiologically stable after cooling or encephalopathy care.
Key medicines
Phenobarbital intravenousCommon first-line neonatal seizure loading is 20 mg/kg IV with cardiorespiratory monitoring; if electrographic seizures continue, specialists may give additional 10 mg/kg loads to a usual cumulative maximum of 40 mg/kg under the neonatal formulary. Maintenance is individualised.