Perinatal asphyxia with hypoxic-ischemic encephalopathy stage I in a late preterm neonate: A case report

Abstract

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality worldwide. It results from impaired gas exchange during the perinatal period, leading to hypoxemia, hypercapnia, and metabolic acidosis. A significant complication is hypoxic-ischemic encephalopathy (HIE), which may cause long-term neurodevelopmental deficits. Early recognition and intervention are critical for preventing progression to severe neurological damage.

Case Presentation: We present the case of a 36-week late preterm male infant weighing 2.771 kg, born via normal vaginal delivery with a tight nuchal cord. Apgar scores were 8 and 9 at 1 and 5 min, respectively. The infant cried after 5–6 seconds but developed respiratory distress within minutes of birth, requiring CPAP support. Neurological examination revealed increased tone, irritability, and exaggerated reflexes—consistent with HIE Stage I. Investigations showed mild bilateral periventricular flare on cranial ultrasound, normal blood glucose, and rising bilirubin levels necessitating phototherapy. Empirical antibiotics were initiated and discontinued after negative cultures. Feeding support and parental counselling were provided.

Outcome: The infant was successfully weaned from oxygen within 7 hours, feeding was established, bilirubin levels normalized, and the baby was discharged on day 3 in stable condition with follow-up planned for neurodevelopmental monitoring.

Conclusion: This case highlights the importance of prompt diagnosis, comprehensive NICU care, and multidisciplinary collaboration in the management of perinatal asphyxia with Stage I HIE, leading to a favourable prognosis.