What are the physical signs of Neonatal Encephalopathy (NE)?

From the Guidelines

Neonatal encephalopathy presents with several recognizable physical signs that indicate brain dysfunction in newborns, including abnormal level of consciousness, abnormal tone, feeding difficulties, and seizures, which are crucial to identify early as they typically develop within the first 24 hours after birth 1. The most common signs of neonatal encephalopathy include:

• Abnormal level of consciousness ranging from lethargy to coma
• Abnormal tone, either hypotonia or hypertonia
• Feeding difficulties
• Seizures
• Abnormal reflexes, particularly diminished or absent Moro, sucking, and grasp reflexes
• Respiratory patterns may be irregular, and the infant might exhibit apnea episodes
• Pupillary responses can be abnormal, and the fontanelle may be full or bulging, suggesting increased intracranial pressure
• Posturing, such as decerebrate or decorticate posturing, indicates severe brain dysfunction
• Autonomic disturbances often manifest as temperature instability, heart rate abnormalities, and blood pressure fluctuations These physical manifestations result from disrupted brain function, often due to hypoxic-ischemic events, metabolic disorders, infections, or structural abnormalities affecting the developing brain. The severity and combination of these signs help determine the grade of encephalopathy (mild, moderate, or severe), which correlates with prognosis. It is essential to note that while other studies discuss various topics such as neonatal drug withdrawal 1 and motor delays 1, the key focus for identifying neonatal encephalopathy remains on the physical signs and symptoms that indicate brain dysfunction in newborns.

From the Research

Physical Signs of Neonatal Encephalopathy (NE)

The physical signs of Neonatal Encephalopathy (NE) include:

• Alterations in mental status 2
• Hypotonia (low muscle tone) 2
• Seizures 2, 3
• Abnormalities in feeding and respiration 2
• Difficulty initiating and maintaining respiration 4
• Abnormal tone and reflexes 4
• Neonatal seizures in varying combinations 4
• Depressed consciousness 4

Specific Clinical Signs

Some specific clinical signs of NE include:

• Low Apgar scores 5, 4
• Acidemia (blood pH < 7.00) 5
• Base deficit ≥ 16 mmol/L 5
• Need for resuscitation at 10 min 5
• Abnormal EEG background features 3
• Electrographic seizures 3
• Electrographic status epilepticus 3

Etiology-Related Signs

The physical signs of NE can also be related to the underlying etiology, such as:

• Signs of hypoxic-ischemic encephalopathy, including low Apgar scores and acidemia 5, 4
• Signs of infection, inflammation, or toxins 4
• Signs of metabolic disease, stroke, or genetic disorders 4
• Signs of placental disease or congenital anomalies 4