Observation and management of infants at risk of neonatal encephalopathy
A Starship Newborn Services guide to observation and management of infants at risk of neonatal encephalopathy
Background
Recognition and documentation of Neonatal Encephalopathy is vital to subsequent management and neonatal outcome. Although the final decision to perform cooling will be determined by the degree of encephalopathy it is important that all infants who are at risk have adequate observation and documentation of the findings.
All babies with abnormal cord gases and/or lactates who are unwell enough to require admission to NICU will be monitored for encephalopathy using the modified Sarnat criteria (see national Neonatal Encephalopathy Consensus Statement).
The majority of babies who are depressed at birth or have abnormal cord gases but respond to resuscitation quickly will not require admission to NICU. Observation on the ward using NOC/NEWS* can be performed as per standard practice.
At birth
Indications for cord blood gas analysis include:
Assisted vaginal birth
Emergency caesarean section
Suspected perinatal asphyxia
Apgar score <4 at 1 min or <7 at 5 min
Neonatal team request
Elevated lactate on point of care testing
After delivery and stabilization examine for neurological signs of an encephalopathy
If the infant is well with no signs of abnormal neurology monitor on post-natal ward using NEWS.
For babies on the postnatal ward who have Apgar ≤7 at 10 minutes or cord pH <7.10 or BE ≤-12 or lactate >6mmol/L repeat and document neurological assessment at 2 hours (must be before 3 hours of age). If neurologically abnormal on assessment after birth, or at 2 hour exam on ward then admit to NICU and perform modified Sarnat scoring.
Consider cotside amplitude integrated EEG monitoring if admitted to NICU.
There should be a low threshold for discussion with Senior Paediatric team/SMO.
inform consultant if any signs of moderate encephalopathy
discuss if appropriate to initiate cooling and/or EEG
Encephalopathy progresses over time so serial observation is important.
Use the Simplified Sarnat screening tool to document status hourly
