Management Metabolic derangements should be managed first Hypoglycemia can be corrected by parenteral administration of a 10% dextrose solution (D10): initial administration should include a bolus of mL/kg followed by continuous dextrose infusion that can be titrated as needed to maintain euglycemia Anything equal to or greater than 25% dextrose solutions should be avoided unless there is a central line or intraosseous access or a patient is refractory to D10 boluses Hypocalcemia should be treated with parenteral infusion of calcium, most often calcium gluconate; concordant hypomagnesemia should be also corrected, as calcium levels may not normalize until serum magnesium normalizes Hyper- or hyponatremia should generally be correctly slowly to avoid sudden fluid shifts in the brain Ongoing seizures caused by hyponatremia will often stop with a simple normal saline bolus of 20 mL/kg; continued seizures due to hyponatremia refractory to standard sodium corrections may require administration of hypertonic saline (3%) at a dose of mL/kg Given the associated risks of hypertonic saline administration, 3% saline is ideally given through a central line Infants at risk for infection or meningitis should be treated with broad-spectrum antibiotics as soon as cultures are obtained The use of antiepileptics is controversial in that some believe only clinical seizures should be treated, while others that only seizures confirmed by EEG should be treated If antiepileptics are administered, the most common treatment includes phenobarbital and phenytoin/fosphenytoin Benzodiazepines are the second most common medications, but the associated sedative effects and potential for respiratory depression requires close monitoring of the infant’s cardiorespiratory status The decision to treat thrombotic cerebrovascular lesions should be made in conjunction with a pediatric hematologist Severe hyperammonemia and other metabolites due to IEM may require dialysis and should be managed in conjunction with a metabolic geneticist Pyridoxine deficiency may respond to parenteral administration of pyridoxine, but requires continuous EEG monitoring to assess effectiveness Neonatal Encephalopathy Goals of Treatment The primary goal of treatment is to identify the encephalopathic newborn, and provide supportive care while determining the etiology of encephalopathy Infants with encephalopathy due to asphyxial events may present in multisystem organ failure as well autonomic instability secondary to brain injury In this instance, goals of treatment include cardiorespiratory stabilization, particularly if there are signs of autonomic dysfunction, and maintaining thermoneutral environment,