Velamentous cord insertion, ischemic-hypoxic encephalopathy and neurological rehabilitation: A case report

Hypoxic-ischemic encephalopathy is a frequent and important cause of neurological problems in the term and preterm newborn. A sentinel event of this entity is the vasa previa, specifically when there is an abnormality of the placenta, type velum insertion of the umbilical cord. There are reports that show the association between these two entities, but the recovery process and neurological prognosis of children with both conditions are scarce in the literature. We present the case of a patient with a history of velum insertion of the umbilical cord and hypoxic-ischemic encephalopathy, who received therapeutic hypothermia (Cool Cap), where his neurological rehabilitation process is described and the percentage of probability of presenting this condition against to the population without these factors. A five-year-old boy with an Apgar index at birth equal to zero at one minute and two at fifteen minutes, who developed severe hypoxic-ischemic encephalopathy secondary to a velum insertion of the umbilical cord without prenatal diagnosis, with great initial neurological and multisystemic compromise. The recovery process included initial multidisciplinary management from neonatal intensive care and a focus on early neurological habilitation. Currently in school, in comprehensive therapies and with physical examination without motor/sensory deficiencies, neuropsychological test suggests risk of attention deficit hyperactivity disorder. Children with severe hypoxic-ischemic encephalopathy usually have disabilities due to motor, cognitive and/or behavioral deficiencies. Having received Cool Cap plus a structured rehabilitation process greatly reduced the expected deficiencies according to prognosis and has promoted satisfactory physical and neurological development.