Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway, ICU – Eligibility Criteria

Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway — ICU

Eligibility Criteria

Review the following criteria to assess neonates symptomatic or at risk for HIE to determine eligibility for neuroprotective care. An examination performed by any experienced neonatal provider is acceptable. Neonate should be resuscitated and allowed to transition. Early abnormal neurologic exams that rapidly improve may not warrant treatment. However, the time window to transition is left to the discretion of the treating providers. To optimize outcomes, expedite transfer to tertiary care facility and initiate therapeutic hypothermia if clinically appropriate within 6 hrs of birth.

This pathway applies to neonates immediately following birth. For post-cardiac arrest management, please refer to the N/IICU Post-cardiac Arrest Care Guidelines.

Neonate Characteristics
  • ≥ 35 0/7 wks of age
  • Birth weight > 1,800 g
Biochemical and Patient History Criteria
  • Blood gas within 1st hr of life
    • Cord, ABG, CBG, VBG
  • pH ≤ 7 or base deficit equal to or worse than -16
  • Alternative Biochemical and Patient History Criteria
    • If no blood gas result available
    • or
    • 1st hr gas pH is between 7.01-7.15
    • or
    • Base deficit 10-15
    • and
    • Both of the following
    • 10 mins Apgar ≤ 5 or assisted ventilation at birth continued for ≥ 10 mins
  • Acute perinatal event:
    • Late and/or variable decelerations
    • Cord prolapse/rupture
    • Uterine rupture
    • Maternal trauma, hemorrhage, cardiorespiratory arrest
    • Shoulder dystocia
    • Nuchal cord
    • Other event leading to occurrence of hypoxia
Degree of Encephalopathy
Must have either of the following findings to be eligible for neuroprotective care:
  • Seizures
  • or
  • Moderate or Severe Encephalopathy (at least 3 findings in moderate/severe categories):
  Severe Encephalopathy Moderate Encephalopathy Mild
Encephalopathy
Level of Consciousness Stupor or coma Lethargic Hyperalert, irritable
Spontaneous Activity No activity Decreased activity Slightly decreased activity
Posture Decerebrate Distal flexion, complete extension Mild distal flexion
Tone Flaccid Alterations in tone Hypertonic
Primitive Reflexes Absent suck
or
Moro		 Weak suck
or
Incomplete Moro		 Suck is usually normal

Moro with low threshold to elicit
Autonomic System Deviated, dilated,
nonreactive pupils

Variable Heart Rate
or
Apnea		 Constricted pupils, bradycardia
or
periodic, irregular breathing		 Normal