Perinatal Asphyxia and Hypoxic-Ischemic Encephalopathy. A Systematic Review

Abstract

Hypoxic-ischemic encephalopathy (HIE) is the leading cause of acquired brain injury and disability in full-term neonates. It is estimated that while the incidence is 1 to 6 per 1,000 live births in developed countries, it can rise to 25 per 1,000 in developing countries, underscoring a significant global disparity. Perinatal asphyxia, defined as a severe impairment in gas exchange during the peripartum, intrapartum, or the first minutes after birth, can cause multi-system damage. This systematic review was conducted following the PRISMA 2020 statement guidelines to ensure transparency and quality. An exhaustive search was carried out in the biomedical databases Scopus and Web of Science. The study selection process involved a two-stage review to identify potentially relevant studies, and ultimately, 19 studies were included in the review. Perinatal asphyxia and HIE have been redefined as a complex syndrome with a multifactorial etiology. The reviewed evidence confirms that therapeutic hypothermia is an effective neuroprotective intervention in high-income countries, but its success is not universal and depends on the available support infrastructure, which explains the discrepancy in results in limited-resource settings. HIE is a multi-systemic syndrome, and the dysfunction of other organs is directly correlated with the neurological prognosis. Finally, multidisciplinary follow-up is essential to address the wide spectrum of long-term sequelae, such as cerebral palsy, epilepsy, and cognitive and learning deficits, which often manifest over time.