Fenichel developed a grading scheme for classifying neonates with hypoxic-ischemic encephalopathy. The author is from Vanderbilt University in Nashville, Tennessee.
Risk factors for major neurologic impairment (pages 263 and 264):
(1) derangements in multiple organs
(2) depressed cerebral function at birth that lasts for days to weeks
(3) deterioration in cerebral function (progression to stupor or coma)
(4) onset of seizures soon after birth
(5) voltage suppression on EEG
Parameters:
(1) mental status
(2) muscle tone and limb movements
(3) seizure activity
(4) spontaneous respirations
(5) reflexes (Moro, tonic neck, muscle stretch)
(6) sucking and swallowing
(7) EEG
(8) cerebral edema (intracranial pressure)
|
Parameter |
Grade I (mild) |
Grade II (moderate) |
Grade III (severe) |
|
mental status |
hyperalert, irritable, jittery |
lethargic or obtunded |
stupor or coma |
|
muscle tone and limb movements |
mild hypotonia, normal at rest; normal limb movements |
moderate hypotonia with decreased limb movements |
severe hypotonia with no limb movements |
|
seizure activity |
none |
present |
increased severity and duration, may show status epilepticus |
|
spontaneous respirations |
normal |
present |
depressed or absent; failure to maintain; requires mechanical ventilation |
|
reflexes |
normal or slightly hyperactive |
depressed |
usually absent |
|
sucking and swallowing |
normal |
variable |
depressed or absent |
|
EEG |
usually normal; may show lack of background variability |
always abnormal; may so seizure activity or voltage suppression |
marked voltage suppression or shows burst-suppression pattern |
|
cerebral edema |
none |
mild to moderate |
moderate to marked |
Specialty: Neurology, Pedatrics
