Improvements in Neonatal Brain Monitoring after Perinatal Asphyxia

textabstractPerinatal hypoxic ischemic encephalopathy (HIE) is a major cause of morbidity and mortality world-wide. Common sequelae in survivors include cerebral palsy (CP), epilepsy and sensory as well as cognitive problems. The consequences of HIE impose significant long-term personal and financial burden on the affected families and the society. The most cost-effective approach to reducing neonatal mortality world-wide would be to improve access to antenatal care4. However, even in developed countries, the exact factors triggering perinatal asphyxia as well as the time of onset of brain injury are often difficult to determine, and it remains a major clinical problem. Seizures commonly occur in the neonate with HIE and are often the only sign of serious underlying brain dysfunction6. Animal studies have shown that neonatal seizures in the context of HIE may cause additional brain injury and that their pharmacological suppression may improve outcome9. Monitoring of brain function using the electroencephalogram (EEG), continuously or by serial EEGs is well-suited to give insight into brain function and its dynamic changes in neonatal HIE and helps to guide treatment as well as prognostication. A good understanding of the pathophysiology of HIE is needed not only in the selection of suitable diagnostic tests and treatment methods, but also to develop new therapeutic strategies