Definition

Encephalopathy is a term that describes a collection of symptoms that cause brain disease or disorder. These diseases or disorders can lead to disturbances in consciousness and personality. Broadly, encephalopathy can be caused by various factors such as bacteria, viruses, or parasites; head tumors; increased pressure on the head; disorders of bodily organs such as kidney disorders and liver disorders; head injuries; and exposure to toxic chemicals.

Hypoxic-ischemic encephalopathy is one type of encephalopathy. Hypoxic-ischemic encephalopathy is one of the leading causes of disability and death in newborns worldwide. This disease is also known by other names such as birth asphyxia, perinatal asphyxia, and neonatal encephalopathy. This condition is characterized by newborns lacking oxygen supply to the brain, thus affecting consciousness, respiration, and reflexes in newborns. Based on global data, the mortality rate of newborns due to hypoxic-ischemic encephalopathy reaches 60%, and those who survive to reach 25%, but experience some severe and permanent neurological symptoms such as cerebral palsy, mental retardation, and epilepsy.

Causes

As the name suggests, the cause of hypoxic-ischemic encephalopathy is a reduction in blood flow to the brain, leading to decreased oxygen levels in the brain. Oxygen is crucial for the proper functioning of all cells in the human body. In newborns, the following issues can lead to hypoxic-ischemic encephalopathy:

• Mismanagement of High-Risk Pregnancies: Women with high-risk pregnancies, such as those with gestational diabetes or preeclampsia, require more stringent monitoring.
• Complications from Umbilical Cord Management: The umbilical cord supplies oxygen to the baby during gestation. Improper management of umbilical cord clamping can drastically increase the risk of oxygen deprivation in the baby.
• Problems with the Placenta or Uterus: The placenta and uterus play a significant role in providing oxygen-rich blood to the baby. Issues such as placental abruption, placenta previa, placental insufficiency, and uterine rupture can contribute to hypoxic-ischemic encephalopathy.
• Infections: Maternal infections can be transmitted to the baby during delivery, particularly if adequate medical interventions are not applied.
• Errors in Fetal Heart Rate Monitoring: If the baby shows signs of fetal distress, immediate action by the doctor or nurse is required to deliver the baby.
• Premature Birth: Premature infants are twice as likely to develop hypoxic-ischemic encephalopathy due to the incomplete development of the lungs and other organs.

Risk factor

Risk factors for hypoxic-ischemic encephalopathy can be assessed from the beginning of pregnancy until delivery. Conditions that can increase the risk of hypoxic-ischemic encephalopathy in newborns include:

• Obese pregnant women, gestational diabetes, preeclampsia, too little or too much amniotic fluid
• Small babies in the womb, known as Intrauterine Growth Restriction (IUGR)
• Multiple pregnancies (twins)
• Alcohol and cigarette consumption during pregnancy
• Autoimmune diseases
• Maternal age under 20 or over 35
• History of complications in previous pregnancies

Symptoms

Symptoms of hypoxic-ischemic encephalopathy include:

 Respiratory problems

• Heart rate problems
• Feeding difficulties
• Loss or decrease of newborn reflexes
• Seizures
• Excessively low or high muscle tone
• Decreased consciousness
• Low APGAR score. The APGAR score is used by pediatric specialists to assess the health of newborns. Normally, the APGAR score ranges from 7 to 10.

Diagnosis

Diagnosis of hypoxic-ischemic encephalopathy is made by the doctor during the delivery process. The doctor will measure fetal movements and fetal heart rate shortly before delivery. After delivery, a pediatric specialist will clean the baby and perform an APGAR score assessment to assess the baby's health. The doctor will check the baby's consciousness, crying, breathing rate, heart rate, reflexes, and muscle strength.

 If there is suspicion of hypoxic-ischemic encephalopathy, the doctor may recommend several diagnostic tests including blood laboratory tests to examine blood gas samples, electrolyte levels in the baby, complete blood tests, and blood sugar levels in the baby. In addition, the doctor may also recommend radiological examinations such as CT scans or MRI to detect brain abnormalities in the baby, and EEG or electroencephalogram examinations if there are seizures in the baby.

Management

The management of hypoxic-ischemic encephalopathy is by meeting the oxygen needs of the newborn by providing respiratory assistance, regulating the baby's temperature, and intensive care by a pediatric specialist. In addition, if there are seizures and additional infections in the baby, the doctor may prescribe medications such as antibiotics and anticonvulsants for the baby. The doctor may also provide stimulation to improve reflexes in newborns.

Complications

The most common complications of hypoxic-ischemic encephalopathy include the possibility of vision impairment in children, cerebral palsy, developmental disorders in children, epilepsy, and in severe cases, death.

Prevention

There is no specific prevention, but you can take several steps during pregnancy to reduce the risk of hypoxic-ischemic encephalopathy. These include:

•  Regular prenatal check-ups: By attending regular prenatal check-ups, you can determine if your pregnancy is at risk, so if it is indeed at risk, healthcare providers can provide better anticipation during your delivery process.
• Consuming nutritious and high-nutrient foods during pregnancy: During pregnancy, it's advisable to meet good nutritional needs for you and your fetus. It is recommended to consume a balanced diet rich in folic acid, vitamin D, iron, and vitamin C. Good nutritional content can be obtained from daily foods rich in vegetables, fruits, and red meat. Foods consumed should also be fully cooked.
• Avoiding excessive sugar and salt intake during pregnancy: Excessive sugar and salt intake during pregnancy can lead to diabetes and high blood pressure during pregnancy, thus increasing the risk of hypoxic-ischemic encephalopathy.
• Adequate water intake: Pregnant women need sufficient fluids to meet the needs of the fetus and amniotic fluid for the baby's growth. Ideally, the required fluid is 1.5 to 2 litres of water per day.
• Avoiding alcohol and cigarette consumption during pregnancy: Alcohol and cigarette consumption during pregnancy are strictly prohibited. Cigarettes referred to include both active and passive smoking.

When to see a doctor?

Hypoxic-ischemic encephalopathy is a condition found when a newborn baby is born, make sure you give birth at a comprehensive healthcare facility with competent pediatric specialists, especially if you have a high-risk pregnancy.

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