How to treat hypoxic-ischemic encephalopathy in premature infants

When facing hypoxic-ischemic encephalopathy in premature infants, it is recommended to adopt supportive therapy, symptomatic treatment and solutions, especially to observe some symptoms of premature infants, such as whether there are cyanosis, difficulty breathing, and monitor the range of blood pressure and blood sugar.

1. Supportive care

Maintain blood gases and pH within normal range: oxygen should be administered to patients with cyanosis or dyspnea; sodium bicarbonate should be used for patients with metabolic acidosis; it has been reported that it can increase blood flow by about 20%. Maintain heart rate, blood pressure, blood sugar, etc. within normal range.

2. Symptomatic treatment

Symptomatic treatment can prevent the already formed pathophysiological changes from further damaging the damaged nerve cells, shorten the course of the disease in the neonatal period, and thus reduce the occurrence of sequelae. The treatment of convulsions, cerebral edema and brainstem symptoms should be active and timely. Once they occur, efforts should be made to control or eliminate them in the shortest possible time.

(1) Reduce intracranial pressure: The increased intracranial pressure in HIE can appear as early as 4 hours after birth and is usually most obvious on the second day. Fluid intake should be appropriately restricted within 3 days after birth. Because asphyxiated children often have increased secretion of antidiuretic hormone and renal damage. The urine volume is often small. If there is increased intracranial pressure on the first day after birth, furosemide or dexamethasone can be used intravenously. Repeat the application after 4 to 6 hours and use it 2 to 3 times in a row so as not to inhibit the body's immune function. If the intracranial pressure is still high after the second day, mannitol can be used by intravenous injection for 2 to 3 times with an interval of 4 to 6 hours. Try to significantly reduce the intracranial pressure within 48 to 72 hours after birth. It is rarely necessary to use it after 72 hours. If the increased intracranial pressure does not decrease for a long time, a CT or B-ultrasound examination should be performed to check for large areas of hypoxic-ischemic damage to the brain parenchyma. Hyperosmotic drugs should be used with caution in the neonatal period, and small doses should be used each time to avoid excessive dehydration of the brain tissue, which may induce intracranial hemorrhage.

(2) Control of convulsions: Children with HIE often experience convulsions within 12 hours after birth. After excluding hypoglycemia and hypocalcemia, phenobarbital is the first choice for controlling convulsions. This drug can reduce the brain metabolic rate and is more suitable for convulsions caused by HIE. Short-acting sedatives such as rectal injection of chloral hydrate or intravenous injection of diazepam may also be added until the clinical symptoms are significantly improved.