This case study is about a neonate with severe Hypoxic-ischaemic encephalopathy, therefore it will take into account pathophysiological, diagnostic and grading issues surrounding HIE, and how these reflect on prognosis.

... This case study is about a neonate with severe Hypoxic-ischaemic encephalopathy, therefore it will take into account pathophysiological, diagnostic and grading issues surrounding HIE, and how these reflect on prognosis; consideration to the ethical issues associated with withdrawal of intensive care support will be made, encapsulating the infant's predicted quality of life; finally, the impact that technology and medical/nursing interventions have upon the NICU environment will then be addressed, demonstrating how NICU's and staff are responding to this. Brain hypoxia and ischaemia from systemic hypoxaemia and reduced cerebral blood flow are the primary triggering events for HIE. A hypoxic-ischaemic insult occurring around the time of birth may result in an encephalopathic state characterised by the need for resuscitation at birth, neurological depression, seizures and electroencephalographic abnormalities, causing significant morbidity and mortality (Shankaran et al, 1991). Hypoxic-ischaemic cerebral injury begins during an asphyxial insult and extends into a recovery period after resuscitation (the

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