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 h. 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.