Clinical Neurologic Examination of Ambalavanan et al for Evaluating a Neonate with Hypoxic-Ischemic Encephalopathy (HIE)

Description

Ambalavanan et al used a standardized neurologic examination to evaluate a neonate with hypoxic-ischemic encephalopathy. This can help identify an infant who requires more aggressive management. The authors are from multiple universities in the United States participating in the National Institute of Child Health and Human Development Neonatal Research Network.

Parameters:

(1) level of consciousness

(2) spontaneous activity

(3) posture

(4) muscle tone

(5) primitive reflexes (suck, Moro)

(6) autonomic system (pupils, heart rate, respiration)

Parameter	Findings	Encephalopathy
level of consciousness	normal	none
	lethargic	moderate
	stupor or coma	severe
spontaneous activity	normal	none
	decreased	moderate
	none	severe
posture	normal	normal
	distal flexion	moderate
	complete extension	moderate
	decerebrate	severe
muscle tone	normal	normal
	hypotonia (focal or generalized)	moderate
	flaccid	severe
sucking reflex	normal	normal
	weak	moderate
	absent	severe
Moro reflex	normal	normal
	incomplete	moderate
	absent	severe
pupils	normal	normal
	constricted	moderate
	deviated	severe
	dilated	severe
	nonreactive to light	severe
heart rate	normal	normal
	bradycardia	moderate
	variable (? labile)	severe
respirations	normal	normal
	periodic	moderate
	apnea	severe

where:

• Seizures are not included here but are seen in other clinical rating systems.

Criteria for encephalopathy: one or more signs in >= 3 of the 6 categories

If encephalopathy is present, then the number of moderate and severe findings are compared.

Findings	Grade of Encephalopathy
moderate > severe	moderate
severe > moderate	severe
moderate = severe	based on level of consciousness

where:

• I would think that the presence of 2 or more severe findings would justify a severe classification and 1 severe finding a moderate-to-severe classification.

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Clinical Neurologic Examination of Ambalavanan et al for Evaluating a Neonate with Hypoxic-Ischemic Encephalopathy (HIE)

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