Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway — ICU

Neuroimaging

MRI	Recommended on DOL 3-5 days after birth, as feasible Diagnostic and prognostic information from the MRI may be more limited after day 5 due to pseudonormalization Consider ordering or arranging MRI/MRS early in admission to ensure ability to acquire by DOL 3-5, as local context allows Strongly consider use of non-pharmacological immobilization for MRI Based on consulting neurologist opinion and results of the first MRI, in a select subset of patients, a second MRI/MRS may be potentially considered on a case-by-case basis (preferably at 10-14 days of life) Repeat imaging should not delay discharge or transfer to another facility
Neurology	Consult as needed for seizure management Formal consultation may be useful after conclusion of therapeutic hypothermia for: MRI interpretation Neuroprognostication Planned follow-up

MRI

Recommended on DOL 3-5 days after birth, as feasible
- Diagnostic and prognostic information from the MRI may be more limited after day 5 due to pseudonormalization
Consider ordering or arranging MRI/MRS early in admission to ensure ability to acquire by DOL 3-5, as local context allows
Strongly consider use of non-pharmacological immobilization for MRI
Based on consulting neurologist opinion and results of the first MRI, in a select subset of patients, a second MRI/MRS may be potentially considered on a case-by-case basis (preferably at 10-14 days of life)
Repeat imaging should not delay discharge or transfer to another facility

Neurology

Consult as needed for seizure management
Formal consultation may be useful after conclusion of therapeutic hypothermia for:
- MRI interpretation
- Neuroprognostication
- Planned follow-up

Note

Where available, telemedicine may be a reasonable mechanism for facilitating joint care decisions and/or formal consultation when Neurology is not available on-site and appropriate agreements exist.

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.