Neonate with severe hypoxic-ischaemic encephalopathy

Paul B.

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Neonate with severe hypoxic-ischaemic encephalopathy

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Abstract

This case study is about a neonate with severe Hypoxic-ischaemic encephalopathy, therefore it will take into account pathophysiological, diagnostic and grading issues surrounding HIE, and how these reflect on prognosis; consideration to the ethical issues associated with withdrawal of intensive care support will be made, encapsulating the infant's predicted quality of life; finally, the impact that technology and medical/nursing interventions have upon the NICU environment will then be addressed, demonstrating how NICU's and staff are responding to this. Brain hypoxia and ischaemia from systemic hypoxaemia and reduced cerebral blood flow are the primary triggering events for HIE. A hypoxic-ischaemic insult occurring around the time of birth may result in an encephalopathic state characterized by the need for resuscitation at birth, neurological depression, seizures and electroencephalographic abnormalities, causing significant morbidity and mortality.

Introduction
The term mentor according to the English National Board
The standard for communication and working relationships
Factors which may affect learning
The Gestalt theory
The importance of the mentor's role in assessing practice
Conclusion
Bibliography

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[...] Mild HIE carries and excellent prognosis; however, there is an increasing risk of death or severe neurodevelopment abnormalities with more severe encephalopathy (Shankaran et al, 1991.See Ben's prognosis in profile). If subsequent disability does develop then neuromotor disability may also be associated with intellectual impairment, blindness and epilepsy (Perlman, 1997). The neuropathology of neonatal HIE varies considerably. In the full term infant pathology is mainly in the cerebral cortex and basal ganglia with the injuries correlating with clinical symptoms such as, disturbances in consciousness, seizures, hypotonia, oculomotor-vestibular abnormalities and feeding difficulties (see Ben's profile). [...]

[...] (2001) Perinatal Asphyxia: A Clinical Review, Including Research With Brain Hypothermia. Neonatal Network. 20(3) April: 31-40. GUNN, A.J., GLUCKMAN, P.D and GUNN, T.R. (1998) Selective Head Cooling in Newborn Infants After Perinatal Asphyxia: a Safety Study (part 1). Pediatrics. 102(4): 885-892. GRAHAM, S. (2001) Neonatal Nurses: Bridging the Gap Between Technology and Caring. Journal of Neonatal Nursing. 29-32. HANDLEY, J. (2003) Decision-making When Not to Treat. Journal of Neonatal Nursing. 83-86. HANRAHAN, J.D., COX, I.J and EDWARDS, A.D. (1998) Persistent Increases In Cerebral Lactate Concentration After Birth Asphyxia. [...]

[...] (2003) The Influence of the Microenvironment. Journal of Neonatal Nursing. 18-21. MARION, D.W., PENROD, L.E and KELSY, S.F. (1997) Treatment of Traumatic Brain Injury With Moderate Hypothermia. New England Journal of Medicine. 336(8): 540-6. PAINTER, M.J., SCHER, M.S and STEIN, A.D. (1999) Phenobarbitol Compared with Phenytoin for the Treatment of Neonatal Seizures. New England Journal of Medicine. 341: 485-489. PERLMAN, J.M. and RISSER, R. (1996) Can Asphyxiated Infants At Risk For Neonatal Seizures Be Rapidly Identified By Current High-Risk Markers? Pediatrics. [...]

[...] (2000) Pilot Study of Treatment with Whole Body Hypothermia for Neonatal Encephalopathy. Pediatrics. 106(4): 684-694. BEAUCHAMP, T and CHILDRESS, J. (1994) Principles of Biomedical Ethics. (4th Ed) New York: Oxford University Press. BLACKBURN, S.T and VANDERBURG, K. (1998) Assessment and Management of Neonatal Neurobehavioural development. In KENNER, C., LOTT, J and FLANDERSMEYER. (Eds) Comprehensive Neonatal Care:A Physiological Approach. Philadelphia: W.B. Saunders. BOYLAN, G.B., RENNIE, J.M., PRESSLER, R.M., WILSON, G., MORTON, M and BINNIE, C.D. (2002) Phenobarbitone, Neonatal Seizures and Video-EEG. [...]

[...] (2002) Use Of Umbilical Artery Base Excess: Algorithm For The Timing Of Hypoxic Injury. American Journal Of Obstetrics And Gynecology. 187(1) July: 1-9. SAFAR, P.J and KOCHANEK, P.M. (2002) Therapeutic Hypothermia after Cardiac Arrest. New England Journal of Medicine. 346(8): 612-613. SCHWARB, S., SCHWARZ, S., SPRANGER, M., KELLER, E., BERTRAM, M and HACKE, W. (1998) Moderate hypothermia in the Treatment of Patients with Severe Middle Cerebral Artery Infarction. Stroke. 29(12): 2461-2466. SEEDHOUSE, D. (1998) Ethics: The Heart of Health Care (2nd Ed) Chichester: John Wiley. [...]

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