Hypoxic Ischemic Encephalopathy

Rasa terpanggil untuk buat kajian tambahan tentang si dia yang datang dekat Tuan Zuhayr lepas dilahirkan. HIE atau Hypoxic Ischemic Encephalopathy diberi nama. Masih ramai yang tak tahu kewujudan istilah ni. Saya sendiri tak tahu sebenarnya. So, ini serba sikit tentang si HIE ni.

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Definition

Hypoxic ischemic encephalopathy (HIE) is a condition in which the brain does not receive enough oxygen. This particular condition refers to an oxygen deficiency to the brain as a whole, rather than a part of the brain. Although the term most often refers to injury sustained by newborns, HIE can be used to described any injury from low oxygen.
HIE can be fatal. Within as little as five minutes of oxygen deprivation, brain cells can begin dying. The disease can also cause long-term damage, including intellectual disability, delayed development, seizures, and cerebral palsy.

Blood Supply to the Brain

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Causes

There are a variety of causes of HIE. Any injury and many health conditions can potentially cause oxygen deprivation to the brain. Some common causes are:

• Injury or complication during birth
• Respiratory failure
• Blocked or ruptured blood vessel
• Carbon monoxide or cyanide poisoning
• Drug overdose
• Drowning
• Lack of oxygen due to smoke inhalation
• Extremely low blood pressure
• Strangulation
• Cardiac arrest
• Carbon monoxide poisoning
• High altitudes
• Choking
• Compression or injury to the trachea that reduces or stops breathing
• Complications from general anesthesia
• Diseases that cause paralysis of the respiratory organs or muscles (eg, myasthenia gravis, Guillain-Barre syndrome)

Risk Factors

Any injury, complication, or condition that causes the brain to have a reduction in blood flow and oxygen deprivation is a risk factor for HIE.

Symptoms

Symptoms include:

• Mild case:
  • Difficulty concentrating or paying attention
  • Poor judgment
  • Poor coordination
  • Euphoria
  • Extreme lethargy

• Severe oxygen deprivation:
  • Seizures
  • Coma
  • No brain stem reflexes (eg, breathing, responding to light)
  • Only blood pressure and heart function reflexes are functioning

Diagnosis

The doctor will work quickly to do a physical exam. Typically, the history is the most important factor in making the diagnosis.
Tests may include the following:

• CT scan —a scan that uses x-rays and computer software to make pictures of your brain
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain
• Electrocardiogram (EKG, ECG) —a test that records the heart’s activity by measuring electrical currents through the heart muscle
• Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
• Blood tests, including arterial blood gases and blood glucose levels
• Electroencephalogram (EEG) —a test that records the brain’s activity by measuring electrical currents through the brain
• Ultrasound—a test that uses sound waves to evaluate blood flow in the vessels going to the brain or within the brain
• Evoked potential test—neurophysiologic test that evaluates functioning of the brain by recording brain waves

Treatment

Treatment depends on the underlying cause of the condition, as well as the severity of the damage to the brain. Treatment options include:

• Life-sustaining treatment—If brain function has stopped but damage is not yet extensive, life-sustaining treatment is administered.
• Mechanical ventilation —This may be needed to sustain breathing.
• Treatments for the circulatory system—Treatments are administered to maintain heart function and control blood pressure.
• Seizure control—Medicine and general anesthesia may be administered to control seizures.
• Cooling—Hypoxic brain damage is often caused by heat. Cooling blankets or other means of cooling may be applied to reduce the body's temperature.
• Hyperbaric oxygen treatment —This treatment is used in cases of carbon monoxide poisoning.

Prevention

In most cases, HIE is unexpected and cannot be prevented. To prevent significant or long-term brain damage once the oxygen supply has been reduced, CPR may be administered.  

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Nak senang cakap, HIE ni dalam Bahasa Melayunya lemas. Tapi kategori lemas HIE ni selalunya diikuti dengan fits atau sawan (moderate to severe). Neonatal HIE bermaksud keseluruhan otak bayi mengalami kekurangan oksigen yang disebabkan paru-paru bayi tak ter'buka' sendiri (tandanya : tak menangis atau born flat). Bila bayi tak menangis setelah dilahirkan, bermakna paru-parunya tak berfungsi lalu menyebabkan otak kekurangan oksigen. Itulah yang berlaku pada Tuan Zuhayr.

Zuhayr dah jalani beberapa ujian daripada sejurus selepas lahir hingga ke umur 4 bulan 2 minggu.

1. EEG atau Electroencephalogram.
Ujian ini dijalankan pada Tuan Zuhayr sebanyak 2 kali. Kali pertama pada hari ke-3 kelahirannya dan kedua pada umur sebulan. Hasil ujian mendapati terdapat Epileptic Discharges at right frontal and left temporal regions (saya sendiri tak tahu apa maksudnya yang sebenar).

2. Hearing Test.
Ujian pendengaran ini juga dilakukan pada Tuan Zuhayr sebanyak dua kali. Pertama pada hari ke-6 atau 7 (tak ingat) dan yang kedua pada hari ke-10. Keputusannya, Tuan Zuhayr lulus! Hore!

3. MRI scan.
Ujian ini dilakukan ketika Tuan Zuhayr berumur 3 bulan. Keputusan ujian berbunyi begini "No Significant Abnormality Detected".

4. Developmental Assesment.
Saringan ini dilakukan oleh Pakar kanak-kanak HTAR ketika Tuan Zuhayr berumur 4 bulan 2 minggu. Menurut doktor tu, dia sendiri terkejut tengok keadaan Zuhayr yang dah macam typical babies. Senyum, gelak, bergolek dan sebagainya.

Zuhayr juga telah jalani rawatan yang diberi nama 'Cooling Therapy' atau Hypothermia. Tuan Zuhayr diselimutkan dengan cooling blanket selama 72 jam sejurus selepas lahir. Rawatan ni bertujuan untuk mengurangkan kerosakan pada otak. Gambar di bawah ni merupakan penjelasan tentang cooling therapy:

 

Mata celik bila ummi panggil.

Gambar ni diambil di hari ke-3 kelahiran. When he is about to 'graduate' from Cooling Therapy. Masa ni dah tak ventilated lagi. Cuma semi oksigen dibekalkan (macam topi astronaut gitu) sebab zuhayr nampak macam susah nak bernafas.

Menurut artikel di atas, tiada cara tertentu untuk menangani kejadian seperti ini. Ia boleh berlaku kepada sesiapapun insan yang dipilih Allah. Mengikut statistik, 1-6 out of 1000 orang bayi akan mengalami HIE tak kiralah sebelum, ketika atau selepas dilahirkan. Jadi, jangan salahkan mana-mana pihak. Ini semua ketentuan Allah. Lainlah kalau terang-terangan salah pihak tertentu seperti biarkan saja baby makan najis sendiri sebab nak tunggu tukar shiftlah apelah.

HIE ni ada tahap-tahapnya. Rujuk gambar di bawah.

Menurut sekumpulan pakar neonatal di NICU HTAR, Zuhayr pada mulanya didiagnos dengan HIE Stage II (moderate). Kemudian esoknya, mereka bertukar fikiran dan catatkan dalam laporan Zuhayr dengan HIE stage III (severe).

Ok, itu serba sedikit pasal HIE. Rasanya fakta ni perlu diketahui umum supaya bila terkena nanti (na'uzubillah), taklah terpinga-pinga macam saya dan suami.

Keadaan sebenar Tuan Zuhayr akan dijelaskan pada next entry.

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