Neonatal encephalopathy (NE), previously known as neonatal hypoxic-ischemic encephalopathy (neonatal HIE or NHIE), is defined as a encephalopathy syndrome with signs and symptoms of abnormal neurological function, in the first few days of life in an infant born after 35 weeks of gestation. In this condition there is difficulty initiating and maintaining respirations, a subnormal level of consciousness, and associated depression of tone, reflexes, and possibly seizures. Encephalopathy is a nonspecific response of the brain to injury which may occur via multiple methods, but is commonly caused by birth asphyxia, leading to cerebral hypoxia. Signs and symptoms
In neonates born at or beyond 35 weeks, neonatal encephalopathy may present itself as the following symptoms:
Reduced level of consciousness
Seizures (which peak at 48 hours)
Difficulty initiating and maintaining respiration
Depression of tone and reflexes

Diagnosis
Cord blood gas analysis can be used to determine if there is perinatal hypoxia/asphyxia, which are potential causes of hypoxic-ischemic encephalopathy or cerebral palsy, and give insight into causes of intrapartum fetal distress. Cord blood gas analysis is indicated for high-risk pregnancies, in cases where C-sections occurred due to fetal compromise, if there were abnormal fetal heart rate patterns, Apgar scores of 3 or lower, intrapartum fever, or multifetal gestation.Evidence of brain injury related to the hypoxic-ischemic events that cause neonatal encephalopathy can be seen with brain MRIs, CTs, magnetic resonance spectroscopy imaging or ultrasounds. Neonatal encephalopathy may be assessed using Sarnat staging. Brain MRI is usually performed within eight days of life.
Bupivacaine/meloxicam, sold under the brand name Zynrelef, is a fixed-dose combination medication used to treat pain in small to medium-sized wounds after surgery. It contains bupivacaine and meloxicam.The most common side effects of bupivacaine/meloxicam are dizziness, constipation, vomiting, and headache.It was approved for medical use in the European Union in September 2020, and in the United States in May 2021. Medical uses
In the European Union, the combination bupivacaine/meloxicam is indicated for treatment of somatic postoperative pain from small- to medium-sized surgical wounds in adults.In the United States it is indicated for soft tissue or periarticular instillation to produce postsurgical analgesia for up to 72 hours after bunionectomy, open inguinal herniorrhaphy, and total knee arthroplasty in adults. References
External links
"Bupivacaine mixture with meloxicam". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT03295721 for "Bunionectomy Study for Postoperative Analgesia (EPOCH 1)" at ClinicalTrials.gov
Clinical trial number NCT03237481 for "Phase 3 Herniorrhaphy Study for Postoperative Analgesia (EPOCH 2)" at ClinicalTrials.gov
Clinical trial number NCT03015532 for "Total Knee Arthroplasty Infiltration Study for Postoperative Analgesia" at ClinicalTrials.gov