Patient's question:
Main symptoms: Arm spasmOnset time: The day before yesterday
Laboratory test results: Abnormal EEG
Doctor's answer:
Hello! Treatment of sequelae of hypoxic brain injury;(1) General treatment: Maintain quietness, oxygen inhalation, warmth, and ensure airway patency. Correct acidosis. For patients with coagulation dysfunction, vitamin K 15 mg/day can be administered, or fresh blood or plasma can be transfused. Promptly correct hypoglycemia, hypocalcemia, and other conditions.
(2) Maintain calorie intake and appropriately restrict fluid volume.
(3) Anticonvulsant treatment: The treatment of neonatal convulsions first involves addressing potential metabolic disorders during HIE, such as hypoglycemia, hypocalcemia, hypomagnesemia, and hyponatremia, and promptly managing them. Once it is determined that the convulsions are not caused by metabolic disorders, anticonvulsant drugs should be used. The principle is to choose one drug with an adequate dose, or to alternate between two drugs. During medication, drug blood concentrations should be monitored frequently, and close observation should be conducted after medication to ensure that convulsions cease, the patient becomes calm and sleeps quietly, breathing and heart rate stabilize, and palm and finger flexion exhibits certain tension.
(4) Treatment of cerebral edema:
1. 20% mannitol
2. Adrenal cortical hormones
3. Control fluid volume
(5) Restore cerebral blood flow volume: When systolic blood pressure is below 6.67 kPa (50 mmHg), dopamine and dobutamine can be administered via intravenous infusion. Start with a small dose and gradually increase to a high dose.
(6) Improve cerebral cell metabolism:
1. Cytidine diphosphate choline 100–125 mg daily, added to 100–150 ml of 10% glucose solution, and administered via intravenous infusion. Begin on the second day of life, once daily, until symptoms improve or discharge.
2. Cerebrolysin 1–2 ml daily, administered via intravenous or intramuscular injection, once daily, with a course of 7–10 days. Two to three courses can be used.
3. Other options include cytochrome C, ATP, and coenzyme A.
(7) Hyperbaric oxygen therapy: Hyperbaric oxygen chamber full-chamber oxygenation can be used, with daily treatment once, an oxygen concentration of 90%–100%, a pressure of 2 kPa, and each session lasting 2 hours. Treatment can be continued for 5–10 sessions, depending on the condition, until clinical symptoms and ultrasound show the disappearance of cerebral edema. For patients with convulsions, enter the chamber after convulsions cease and breathing and pulse stabilize. For those with intracranial hemorrhage, enter the chamber 6 hours after stabilization.