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Hypoxic-ischaemic encephalopathy — RACP Paediatrics MCQ

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HardNeonatologyHypoxic-ischaemic encephalopathyRACP Paediatrics

A term infant has Apgar scores of 2 and 5 after shoulder dystocia. At 2 hours of age he is encephalopathic with hypotonia, poor suck and recurrent seizures; cord pH was 6.92 with base excess minus 18. What is the most appropriate management?

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Correct answer: C — Commence therapeutic hypothermia after neonatal retrieval consultation

Moderate to severe hypoxic-ischaemic encephalopathy within the first 6 hours with significant metabolic acidosis is an indication to consider therapeutic hypothermia in a neonatal intensive care pathway. Cranial ultrasound is not required before treatment and can miss early injury. The pearl is that timing is crucial: cooling is neuroprotective when started promptly in eligible infants.

Reference: RCH Clinical Practice Guidelines: Neonatal seizures; Therapeutic Guidelines (eTG)