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

Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway — ICU

Neuroimaging

MRI
  • Recommended on DOL 3-5 days after birth, as feasible
    • Diagnostic and prognostic information from the MRI may be more limited after day 5 due to pseudonormalization
  • Consider ordering or arranging MRI/MRS early in admission to ensure ability to acquire by DOL 3-5, as local context allows
  • Strongly consider use of non-pharmacological immobilization for MRI
  • Based on consulting neurologist opinion and results of the first MRI, in a select subset of patients, a second MRI/MRS may be potentially considered on a case-by-case basis (preferably at 10-14 days of life)
  • Repeat imaging should not delay discharge or transfer to another facility
Neurology
  • Consult as needed for seizure management
  • Formal consultation may be useful after conclusion of therapeutic hypothermia for:
    • MRI interpretation
    • Neuroprognostication
    • Planned follow-up

Note

Where available, telemedicine may be a reasonable mechanism for facilitating joint care decisions and/or formal consultation when Neurology is not available on-site and appropriate agreements exist.