NEUROPROTECTION IN NEONATAL HYPOXIC ISCHEMIC ENCEPHALOPATHY: THERAPEUTIC HYPOTHERMIA AND BEYOND

Abstract

Perinatal Asphyxia continues to be a major cause of neonatal mortality and morbidity even in the
most technologically advanced and prosperous countries of the world. The incidence remains unchanged; 1-
2% of live births in developed world countries1 and much higher in developing world countries2 The
Indian National Neonatal Perinatal Database reported an incidence of 5% among studies conducted in
sixteen medical institutes2. Perinatal Asphyxia is a multisystem disorder. Neonatal brain is the most
important organ affected by Asphyxic insult because the resulting neuronal damage is permanent. Hypoxic
Ischemic Encephalopathy (HIE), the pathognomonic clinical syndrome of asphyxic neuronal insult, occurs
in 50-60% of babies with Perinatal Asphyxia3. Moderate and severe HIE causes significant neonatal
mortality and morbidity4. Among patients with moderate HIE, 10-20% die and 30-40% develop
neurological deficit, whereas 50% of patients with severe HIE die and almost all survivors develop
neurological deficits5. Hence the toll on the society continues to be very high in spite of dramatic
improvements in neonatal intact survival, particularly in developed world countries.