This case study is about a neonate with severe Hypoxic-ischaemic encephalopathy, therefore it will take into account pathophysiological, diagnostic and grading issues surrounding HIE, and how these reflect on prognosis; consideration to the ethical issues associated with withdrawal of intensive care support will be made, encapsulating the infant's predicted quality of life; finally, the impact that technology and medical/nursing interventions have upon the NICU environment will then be addressed, demonstrating how NICU's and staff are responding to this. Brain hypoxia and ischaemia from systemic hypoxaemia and reduced cerebral blood flow are the primary triggering events for HIE. A hypoxic-ischaemic insult occurring around the time of birth may result in an encephalopathic state characterized by the need for resuscitation at birth, neurological depression, seizures and electroencephalographic abnormalities, causing significant morbidity and mortality.
[...] Mild HIE carries and excellent prognosis; however, there is an increasing risk of death or severe neurodevelopment abnormalities with more severe encephalopathy (Shankaran et al, 1991.See Ben's prognosis in profile). If subsequent disability does develop then neuromotor disability may also be associated with intellectual impairment, blindness and epilepsy (Perlman, 1997). The neuropathology of neonatal HIE varies considerably. In the full term infant pathology is mainly in the cerebral cortex and basal ganglia with the injuries correlating with clinical symptoms such as, disturbances in consciousness, seizures, hypotonia, oculomotor-vestibular abnormalities and feeding difficulties (see Ben's profile). [...]
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