Paula had Hypoxic Ischemic Encephelopathy at birth.

Do you need to know this to make the diagnosis? [see previous blog-post – What Do You Think The Diagnosis Is?].

As long as the vital signs [including baseline respiratory rate and depth] are carefully looked at and measured, then you do not meed to know this in order to make the diagnosis. The knowledge of Paula’s birth history, however, will help explain her ventilatory defect. Since breathing was a problem from the onset, and since breathing involves the motor ability to move air in and out of the body, this should be looked at very carefully by counting the resting respiratory rate as a crucial first step. This will unmask broken breathing [as I call it] or permanent respiratory defects which make PCO2 in the blood more difficult to manage.

Respiratory Rate and Tidal Volume are especially important in assessing the damage to factors affecting the complex motor act of moving air in and out of the body. We take this ability for granted because it is unconscious, co-ordinated by the periphery and the brainstem and the circulatory system.

Other unusual hidden adaptations [metabolic, hemodynamic, renal, cardiac and neurologic] are likely to have occurred, all to help the neonate survive, if possible, and may last through life.

Paula’s birth explains the permanently abnormal respiratory rate and minute ventilation….see all relevant past posts.


Hypoxic-ischemic encephalopathy (HIE) can have both transient and long-lasting effects on the neonate, including neurologic, renal, cardiac, hepatic, and hematologic. Both the disease process and the treatment option of therapeutic hypothermia can result in hemodynamic instability. Understanding the effects of HIE on the neonatal myocardium, pulmonary vascular bed, and the cardiac dysfunction that can occur is key to managing infants with HIE. This article focuses on causes of hemodynamic instability in neonates following perinatal asphyxia and how to recognize hemodynamic compromise. It reviews the underlying pathophysiology and associated management strategies to improve hemodynamics and potentially improve outcomes.

Keywords: cardiovascular status; hypoxic-ischemic encephalopathy (HIE); hemodynamics; neurology Hemodynamic Instability in Hypoxic Ischemic Encephalopathy: More Than Just Brain Injury—Understanding Physiology, Assessment, and Management Sharifa HabibJennie SainiStephanie AmendoeiraCarol McNair Neonatal Netw 2020 May 1;39(3):129-136. doi: 10.1891/0730-0832.39.3.129.

It seems obvious to Paula and I, that all healthy living adults have made that first transition from an aquatic environment [the womb] to air more or less successfully and some or all may have hidden anomalies that produce difficulties [syndromes -a recognizable collection of signs and symptoms ] that are generally protective, but that can begin to fail with the hormonal changes and physical of development, the longer one lives.

This, it seems, is a part of Paula’s life story.

To Be Continued……….


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