1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-6-41 10.15844/pedneurbriefs-6-6-1 Neonatal Encephalopathy Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Classification of Newborn Encephalopathy http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 06 1992 01 07 2016 6 6 41 42 Copyright: © 1992 The Author(s) 1992 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Problems with definitions and classifications of newborn encephalopathy

Investigators from the Department of Neurology, Children’s Hospital and Harvard Medical School, Boston and the Neuroepidemiology Branch, Bethesda take issue with the terms hypoxic-ischemic and post-asphyxial encephalopathy when the etiology is frequently in doubt.

 Newborn Encephalopathy Hypoxic-Ischemic Encephalopathy Metabolic Disorders

Investigators from the Department of Neurology, Children’s Hospital and Harvard Medical School, Boston and the Neuroepidemiology Branch, Bethesda take issue with the terms hypoxic-ischemic and post-asphyxial encephalopathy when the etiology is frequently in doubt. These authors prefer the simple descriptive terms, neonatal or newborn encephalopathy for infants with a clinically defined syndrome of impaired neurologic function, which includes lethargy, coma, hypotonia, impaired primitive reflexes, depressed or absent respirations and seizures. Difficulties in initiating respiration and maintaining tone and consciousness may be caused by factors that predate birth or onset of labor. Neonatal encephalopathy grading schemes previously described in the literature (Sarnat and Sarnat, Low et al, Levene et al, Amiel-Tilson and Ellison, Fenichel) are considered qualitative rather than quantitative and their potentially correctable limitations are discussed. [1]

COMMENT. In a previous issue of Pediatric Neurology [2], Dr. Alan Hill of the University of British Columbia Children’s Hospital, Vancouver, reviewed the diagnosis, classification, pathology and management of hypoxic-ischemic cerebral injury in the term newborn. Grade III severe HIE, manifested by coma, hypotonia, seizures, abnormal brain stem and autonomic function, and increased intracranial pressure, is associated invariably with death or severe neurologic sequelae. Grade II moderate HIE, with lethargy/stupor, hypotonia, suppressed reflexes and seizures, has a poor outcome in 20-40% of infants. Grade I mild HIE, characterized by hyperalertness, jitteriness, exaggerated Moro and stretch reflexes, is transient with duration less than 24 hours and recovery is complete. The author emphasizes that the clinical features of hypoxic-ischemic encephalopathy are not specific and that similar symptoms may be caused by metabolic disorders, infection or cerebral dysgenesis.

 Leviton A Nelson KB Problems with definitions and classifications of newborn encephalopathy Pediatr Neurol 1992 Mar-Apr 8 2 85 90 10.1016/0887-8994(92)90026-U 1580965 Hill A Current concepts of hypoxic-ischemic cerebral injury in the term newborn Pediatric Neurology 1991 Sep-Oct 7 5 317 325 10.1016/0887-8994(91)90060-X 1764132