Treatment criteria:
Criterion A: Newborns of more than 34 completed weeks of GA with at least 1 of the parameters of severe acidosis:
- Apgar score less than 5 at 5 minutes.
- Resuscitation in the delivery room for more than 10 minutes, via positive pressure ventilation (face mask or endotracheal tube).
- pH less than 7 in the worst blood gas analysis during the first hour of life (cord, arterial, venous, or capillary blood).
- Base deficit greater than 16 mmol/L in the worst blood gas analysis during the first hour of life (cord, arterial, venous, or capillary blood).
Criterion B. All newborns who meet Criterion A will be neurologically evaluated using Criterion B.
- Seizures.
- Clinical signs of moderate or severe HIE: The following 3 criteria must be met:
- Altered state of consciousness (diminished or absent response to stimulation).
- Abnormal tone (focal or generalized hypotonia).
- Abnormal primitive reflexes (weak/absent suck, abnormal Moro, etc.).
Criterion C: Electroencephalographic tracing. As soon as possible, and for at least 30 minutes, activity will be monitored with aEEG.
Two situations may occur:
- Normal aEEG (CNV): within the first 6 hours of life, this indicates a high probability of normal neurological prognosis and, if the neurological examination is consistent (mild HIE), discontinuation of hypothermia will be considered. Whenever possible, it should be confirmed with a conventional EEG.
- Altered aEEG: Corroborates the diagnosis of moderate-severe HIE, and treatment must be maintained for 72 hours:
- Normal baseline tracing (CNV) with seizures.
- Status epilepticus.
- Altered baseline tracing: DNV, burst-suppression.
- Suppressed baseline tracing: low voltage, isoelectric.
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