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The importance of not increasing confusion around neonatal encephalopathy and hypoxic-ischemic encephalopathy

Pediatric Research volume 95, pages 871–872 (2024)Cite this article

Acute neonatal encephalopathy (NE) remains a major problem at all gestational ages. In term and near-term infants, the single most common cause of acute NE is hypoxia-ischemic encephalopathy (HIE). The successful translation of therapeutic hypothermia to routine care illustrates the value of large, well-designed randomized studies.1 The key challenge is to find adjunct therapies that can safely further improve outcomes.2 In this issue Quirke and colleagues argue that consistent outcome measures in studies of NE will help to improve the utility of future trials.3 However, referring to these as outcomes of NE is confusing and very misleading.

NE is simply defined as a disturbed neural function in the newborn, with the cardinal feature of an altered level of consciousness, often associated with seizures, whether unilateral or bilateral, cranial nerve abnormalities, altered tone and power and/or autonomic dysfunction. No other information is needed to make this diagnosis. Given the diverse range of etiologies, it is vanishingly unlikely that there could ever be a treatment trial for generic NE.4 Thus, we need to specify, in advance, whether NE is most likely caused by HIE, stroke, intraventricular hemorrhage, infection, metabolic derangement or disorder, genetic epilepsy/encephalopathy or some other cause. The correct management and outcomes must be different for each of these.5 Interestingly, in one cohort of infants with NE not due to HIE, 28/193 had a specific genetic diagnosis.6

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Funding

This manuscript was supported by the Health Research Council of New Zealand (22/559).

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Authors and Affiliations

  1. Department of Physiology, The University of Auckland, Auckland, New Zealand

    Alistair J. Gunn

  2. Department of Neurology, Harvard Medical School, Boston, MA, USA

    Janet S. Soul

  3. Department of Pediatrics, Washington University, St. Louis, MO, USA

    Zachary A. Vesoulis

  4. Departments of Neurology and Pediatrics, University of California, San Francisco, CA, USA

    Donna M. Ferriero

Authors
  1. Alistair J. Gunn
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  2. Janet S. Soul
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  3. Zachary A. Vesoulis
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  4. Donna M. Ferriero
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A.J.G., J.S.S., Z.V. and D.F. contributed to the conception and design of the manuscript, drafting the article and approving the final version.

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Correspondence to Alistair J. Gunn.

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Gunn, A.J., Soul, J.S., Vesoulis, Z.A. et al. The importance of not increasing confusion around neonatal encephalopathy and hypoxic-ischemic encephalopathy. Pediatr Res 95, 871–872 (2024). https://doi.org/10.1038/s41390-023-03001-6

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