Cerebral edema in HIE

Cerebral edema and increased ICP(>10mmHg) are actually fairly uncommon concomitants of perinatal asphyxia.When present,they more often reflect extensive prior cerebral necrosis rather than swelling of intact cells,and because they bespeak such extensive cell death,they have a uniformly bad prognosis.They peak 36 to 72 hours after the insult.They are more properly regarded as an effect rather than a cause of brain damage.For this reason,efforts specially to reduce cerebral edema or ICP do not affect outcome;neither do ICP elevations reduce cerebral perfusion or introduce any acute functional neurologic disturbances.Therefore,such interventions previously explored in the literature as antiedema agents(e.g.,high-dose phenobarbital,steroids,mannitol,and other hypertonic solutions) are not employed at our institution.The infant's patent sutures and open fontanel are protective of any acute increases in ICP that might occur.Our major efforts are devoted to ensuring an adequate CPP through maintaining an adequate systemic mean arterial BP,shown in recent studies to be a more important variable than ICP in ensuring adequate CBF.
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