Epidemiology and Clinical Significance
- Incidence and Global Burden
- HIE occurs in approximately 1–8 per 1000 live births globally (Lee et al., 2013).
- Most significant neurological disorder in neonates (Ferriero, 2004; Volpe, 2008).
- Incidence declining in some low-income countries due to improved obstetric care (Smith et al., 2000; Becher et al., 2007).
- More than 90% of infants with HIE are born in middle- and low-income countries, reflecting a disproportionate global burden (Lee et al., 2013).
Aetiology and Risk Factors
- Severe condition with high morbidity and mortality:
- 15–30% of affected infants die during neonatal period.
- Additional 25–35% develop permanent neurological sequelae, including cerebral palsy (CP) and cognitive impairment (Volpe, 2008; Lee et al., 2013).
Terminology: Neonatal Encephalopathy vs. HIE
- Reevaluation of Hypoxia’s Role
- Historically, perinatal hypoxia was considered the primary cause of neonatal encephalopathy, cognitive impairment, and CP. This relationship has been reconsidered as possibly overrated (Freeman & Nelson, 1988; Bax & Nelson, 1993; Nelson & Blair, 2015).
- Badawi et al. (1998) identified multiple antenatal risk factors such as maternal infertility treatments and thyroid disease. However, their broad definition included infants with genetic and congenital abnormalities.
Pathogenesis of Hypoxic–Ischaemic Encephalopathy (HIE)
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