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Back| 1. Diagnostic Criteria for Neonatal Hypoxic-Ischemic Encephalopathy |
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| 1. Clear obstetric history of abnormal conditions leading to fetal distress, severe fetal distress (fetal heart rate <100 beats/min for more than 5 minutes; and/or grade III amniotic fluid contamination), or significant asphyxia during delivery; |
| 2. Severe asphyxia at birth, defined as an Apgar score of ≤3 at 1 minute and continuing to ≤5 at 5 minutes, and/or umbilical artery blood gas pH ≤7.00 at birth; |
| 3. Neurological symptoms appearing shortly after birth and lasting for more than 24 hours, such as altered consciousness (hyperexcitability, lethargy, coma), changes in muscle tone (increased or decreased), abnormal primitive reflexes (weak or absent sucking, Moro reflex), seizures in severe cases, brainstem signs (altered breathing patterns, changes in pupil size, sluggish or absent light reflex), and increased anterior fontanel tension; |
| 4. Exclusion of seizures caused primarily by electrolyte disturbances (hypocalcemia, hypoglycemia, etc.), birth trauma, intracranial hemorrhage, intrauterine infection, genetic metabolic diseases, and other congenital conditions causing brain injury. |
| 2. Clinical Grading of Neonatal Hypoxic-Ischemic Encephalopathy | |||||||||
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| Grade | Consciousness | Muscle Tone | Primitive Reflexes | Seizures | Central Respiratory Failure | Pupil Changes | EEG | Course and Prognosis | |
| Moro Reflex | Sucking Reflex | ||||||||
| Mild | Alternating excitement and inhibition | Normal or slightly increased | Active | Normal | May have myoclonus | None | Normal or dilated | Normal | Symptoms disappear within 72 hours, good prognosis |
| Moderate | Lethargy | Decreased | Decreased | Decreased | Common | Present | Often constricted | Low voltage, may have epileptiform discharges | Symptoms disappear within 14 days, possible sequelae |
| Severe | Coma | Absent | Absent | Absent | Present, may be continuous | Significant | Asymmetric or dilated, sluggish light reflex | Suppression-burst, isoelectric | Symptoms may last for weeks, high mortality rate, survivors often have sequelae |
Explanation
Diagnosis can be confirmed if all four criteria are met; if the fourth criterion is uncertain, it can be considered a suspected case.
China revised the diagnostic criteria for neonatal HIE in 1989 (Jinan) and 1996 (Hangzhou), and in 2005, the Neonatology Group of the Chinese Medical Association Pediatrics Branch established the diagnostic criteria for full-term neonatal HIE.
1. Clinical manifestations are the main basis for diagnosing HIE, but it should be noted that to clarify the pathological type of HIE, especially to differentiate it from diseases with similar clinical manifestations (such as central nervous system congenital malformations, infections, hypoglycemia, and genetic metabolic diseases), and to determine the prognosis, imaging examinations are required.
2. The neurological symptoms of HIE change after birth, symptoms may gradually worsen, generally peaking at 72 hours, and then gradually improve, but severe cases may deteriorate. Careful dynamic observation of neonatal neurological symptoms within 3 days of birth and grading is required.
