(A) Hypoxic Ischemic Encephalopathy # HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE) It is a type of brain damage that occurs when an infant's brain doesn't receive enough oxygen and blood. It is a dangerous condition that requires immediate medical intervention. HIE affects 20 out of every 1000 full term births; the incidence rate in premature babies is 60% of all live births.# Causes of Neonatal Seizures:> Seizures resulting from hypoxic-ischemic encephalopathy Seen in both term and premature infants. Present within the first 72 hours of life. Seizures may include subtle, clonic, or generalized seizures.> Intracranial hemorrhage: Occurs more frequently in premature than in term infants. Distinguishing infants with pure hypoxic-ischemic encephalopathy from those with intracranial hemorrhage often is difficult.> Subarachnoid hemorrhage: More common in term infants. Type of hemorrhage occurs frequently and is not clinically significant. Typically, infants with subarachnoid hemorrhage appear remarkably well.> Germinal matrix-intraventricular hemorrhage: Is seen more frequently in premature than in term infants, particularly in infants born prior to 34 weeks' gestation. Subtle seizures are seen frequently with this type of hemorrhage.> Subdural hemorrhage: Is seen in association with cerebral contusion. It is more common in term infants.> Metabolic disturbances: Include Hypoglycemia, Hypocalcemia, & Hypomagnesemia. Less frequent metabolic disorders, such as inborn errors of metabolism, are seen more commonly in infants who are older than 72 hours. Typically, they may be seen after the infant starts feeding.> Intracranial infections (which should be ruled out vigorously) that are important causes of neonatal seizures include Meningitis, Encephalitis (including herpes encephalitis), Toxoplasmosis, and Cytomegalovirus (CMV) infections. Most common bacterial pathogens include Escherichia coli and Streptococcus pneumoniae.> Most cerebral malformations present with seizures at a later age, major malformation syndromes are important to consider.> Lissencephaly, pachygyria, polymicrogyria, and linear sebaceous nevus syndrome can present with seizures in the neonatal period.