Hypoxic-Ischemic Encephalopathy (HIE) in Term and Near-Term Infants

Hypoxic-ischemic encephalopathy (HIE) remains a major burden for infants, their families, and society all over the world, while the incidence of HIE has fallen slightly in high-income countries (HICs) that is not the situation in many poorer economic environments. Still, in many cases, a clear cause for and the timing of the insult remains unclear. The introduction of therapeutic cooling in HICs for moderate and severe HIE has resulted in better early recognition of encephalopathy, better monitoring with EEG, and an emphasis on optimal early management with early seizure treatments and outcome prediction. In turn, this has led to significant improvements in outcomes though some infants still have moderate to severe long-term problems affecting all developmental domains and some do not survive. Studies remain in progress as to whether mild HIE should be treated with cooling, whether cooling should be used in different clinical settings, and whether additional neuroprotective agents can further improve outcome. Nowadays most children in HICs survive with good early outcomes, but data from school-age follow-up has allowed much better recognition of more subtle but significant longer-term problems affecting memory, cognition, and minor motor skills, making long-term follow-up essential. MR brain imaging remains the best individual modality for outcome prediction.