Behandlungskriterien:
Kriterium A: Neugeborene, die älter als 34 Wochen sind, haben die GA mit mindestens einem der schweren Azidoseparameter abgeschlossen:
- Apgar weniger als 5 nach 5 Minuten.
- Wiederbelebung im Kreißsaal für mehr als 10 Minuten unter Verwendung von Überdruckbeatmung (Maske oder Endotrachealtubus).
- pH-Wert unter 7 in der schlechtesten Gasometrie der ersten Lebensstunde (Nabelschnur-, arterielles, venöses oder kapillares Blut).
- Basendefizit größer als 16 mmol/L bei der schlechtesten Blutgasanalyse der ersten Lebensstunde (Nabelschnur-, arterielles, venöses oder kapillares Blut).
Kriterium B. Alle Neugeborenen, die Kriterium A erfüllen, werden anhand von Kriterium B neurologisch untersucht.
- Anfälle.
- Mittelschwere oder schwere HIE-Symptome: Die folgenden 3 Kriterien müssen erfüllt sein:
- Veränderter Bewusstseinszustand (verminderte oder fehlende Reaktion auf Stimulation).
- Abnormaler Tonus (fokale oder generalisierte Hypotonie).
- Abnormale primitive Reflexe (schwaches/fehlendes Saugen, abnormales Moro usw.).
Kriterium C: Elektroenzephalographische Aufzeichnung. Sobald wie möglich und mindestens 30 Minuten lang wird die Aktivität mit einem EEG überwacht.
Es können zwei Situationen auftreten:
- Normales aEEG (CNV): In den ersten 6 Lebensstunden weist dies auf eine hohe Wahrscheinlichkeit einer normalen neurologischen Prognose hin. Wenn die neurologische Untersuchung konsistent ist (milder HIE), wird ein Absetzen der Hypothermie in Betracht gezogen. Wann immer möglich, sollte es einem konventionellen EEG gegenübergestellt werden.
- Verändertes aEEG: Bestätigt die Diagnose eines mittelschweren bis schweren HIE und die Behandlung sollte 72 Stunden lang fortgesetzt werden:
- Normales Baseline-Tracing (CNV) mit Anfällen.
- Status epileptisch.
- Veränderte Basisverfolgung: DNV, Ausbruchsunterdrückung.
- Unterdrückte Basisspur: Niederspannung, isoelektrisch.
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