Favorable Outcome in a Neonate with Methamphetamine, Tobacco, and Alcohol Exposure with Hypoxic Ischemic Encephalopathy Managed Using Therapeutic Hypothermia

This report details the management of a neonate with moderate Hypoxic Ischemic Encephalopathy (HIE) and prenatal polysubstance exposure. Born at 36 weeks gestation following maternal methamphetamine, tobacco, and alcohol use, the infant suffered a placental abruption. Therapeutic cooling was initiated at three hours of life for 72 hours. While urine toxicology confirmed methamphetamine exposure, Neonatal Abstinence Syndrome (NAS) scores remained below the pharmacological threshold. Despite limitations in advanced neurophysiological monitoring common in resource-limited settings, the infant’s recovery was successfully managed through diligent clinical monitoring, supportive care, and early multidisciplinary neurodevelopmental follow-up. Notably, an average Battelle Developmental Inventory score administered at 5 months of age showed promise, but long-term monitoring is needed given the patient's high-risk prenatal history. • This case illustrates the successful use of therapeutic hypothermia for severe Hypoxic Ischemic Encephalopathy in a high-risk neonate complicated by prenatal exposure to methamphetamine, tobacco, and alcohol. • Despite confirmed toxicological exposure, the infant displayed a favorable neurodevelopmental recovery with Neonatal Abstinence Syndrome scores consistently remaining below the threshold for pharmacologic intervention. • While the medical outcome was positive, the patient's discharge required complex coordination with social services and eventual placement in a children's home due to the safety risks posed by maternal substance abuse.