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Hypoxic-Ischemic Encephalopathy

Birth Anoxia

Hypoxic ischemic encephalopathy (HIE) or birth asphyxia in neonates is a type of brain dysfunction that occurs when the brain doesn't receive enough oxygen or blood flow for a period of time before, during, or after birth and occurs in 1.5-3/1000 live births.  It can lead to severe complications, even death. Most common complications are delayed development, epilepsy, motor impairment, neurodevelopmental delay, and cognitive impairment. Usually, the severity of impairment cannot be determined until a child is three to four years old at which point commonly Cerebral Palsy is diagnosed.

Current treatment in the West consists mainly of best supportive care in the first days after birth. But this precious time after birth is crucial for active reversal of hypoxia in the brain and limiting the damage. In China for instance, including hyperbaric oxygen therapy in neonates to treat this condition significantly reduces mortality and neurological sequelae such as epilepsy, mental retardation, and cerebral palsy. The studies focus on term babies and undoubtedly there is solid clinical evidence that the damage of HIE can be reversed.

Click here to access the systematic review of 20 Chinese trials found that treatment with hyperbaric oxygen could significantly reduce the mortality and neurological deficit in term newborn babies.

In Europe the proactive approach in birth anoxia is physiotherapy in first months after birth using the Vojta protocol  where the therapist activates the reflex locomotion thru stimulation of pressure points on a baby's body. Through this technique, the baby is taught crawling and rolling thru the reflex action. In addition, the muscular activities in other body parts are strengthened preventing spastic paralysis, typical for cerebral palsy. Furthermore, combination of this type of newborn physiotherapy with hyperbaric oxygen therapy yielded better results, with faster recovery.

Hyperbaric oxygen therapy ....

Further reading:
  1. Zulian Liu, Tengbin Xiong, Catherine Meads, Clinical effectiveness of treatment with hyperbaric oxygen for neonatal hypoxic-ischaemic encephalopathy: systematic review of Chinese literature, BMJ, doi:10.1136/bmj.38776.731655.2F (published 11 May 2006)
  2. B D Baĭborodov, T V Savel'eva, V M Prokopenko, I I Evsiukova, A V Arutiunian, [Effects of hyperbaric oxygenation on free radical oxidation and antioxidant system of blood in the newborn who had acute hypoxia at birth], Anesteziol Reanimatol. Nov-Dec 1996;(6):56-8.
  3. Baĭborodov, B. D., Savel'eva, T. V., Prokopenko, V. M., Evsiukova, I. I., & Arutiunian, A. V. (1996). Vliianie giperbaricheskoĭ oksigenatsii na svobodnoradikal'noe okislenie i antioksidantnuiu sistemu krovi novorozhdennykh deteĭ, perenesshikh ostruiu gipoksiiu pri rozhdenii [Effects of hyperbaric oxygenation on free radical oxidation and antioxidant system of blood in the newborn who had acute hypoxia at birth]. Anesteziologiia i reanimatologiia, (6), 56–58.
  4. Koren G, Sharav T, Pastuszak A, Garrettson LK, Hill K, Samson I, Rorem M, King A, Dolgin JE. A multicenter, prospective study of fetal outcome following accidental carbon monoxide poisoning in pregnancy. Reprod Toxicol. 1991;5(5):397-403. doi: 10.1016/0890-6238(91)90002-w. PMID: 1806148.
  5. Zhang L, Cai L, Zhang W. [A pathological survey of the therapeutic effect on experimental hypoxic-ischemic encephalopathy]. Zhonghua Bing Li Xue Za Zhi. 1996 Apr;25(2):102-4. Chinese. PMID: 9206216.
  6. Wattel F, Mathieu D, Mathieu-Nolf M. Devenir des enfants intoxiqués au monoxyde de carbone en période foetale et traités par oxygéno- thérapie hyperbare--etude d'une cohorte constituée sur 25 ans de 1983 a 2008 [A 25-year study (1983-2008) of children's health outcomes after hyperbaric oxygen therapy for carbon monoxide poisoning in utero]. Bull Acad Natl Med. 2013 Mar;197(3):677-94; discussion 695-7. French. PMID: 25163349.

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