Neonatal encephalopathy, hypoxic-ischaemic encephalopathy (HIE) and perinatal asphyxia are often used interchangeably. This international real-time Delphi process, published in July, gathered 378 responses from 52 countries — a fifth from low- and middle-income countries and including parents — and held three consensus meetings.
The agreed primary definition: neonatal encephalopathy is a heterogeneous clinical condition of abnormal or impaired brain function with multiple potential causes. It presents with an altered level of consciousness and may include seizures, abnormal reflexes, altered tone, posture or movements, or an abnormal brain-related breathing pattern, and carries a heightened risk of morbidity and death.
The practical point is in the wording. Encephalopathy is the clinical picture; hypoxia-ischaemia is one cause. Labelling every encephalopathic newborn as 'asphyxia' can close off the search for infection, metabolic disease, stroke or genetic causes, and it shapes what families are told.
- Describe an encephalopathic newborn as having neonatal encephalopathy until the cause is established.
- Reserve 'hypoxic-ischaemic encephalopathy' for cases with evidence of a perinatal hypoxic-ischaemic event.
- Look for other causes: sepsis, meningitis, hypoglycaemia, metabolic disorders, stroke, genetic conditions.
- Document level of consciousness, tone, reflexes, seizures and breathing pattern at presentation.
- Use precise terms with families; 'asphyxia' can imply blame that the evidence may not support.
Why it matters
Precise terminology keeps the diagnostic search open and makes research and counselling more accurate.
Don't overread it
This is a consensus definition, not a validated diagnostic or treatment criterion.
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