What is Hypoxic Ischemic Encephalopathy?

Hypoxic ischemic encephalopathy, also referred to in short as HIE, is a type of brain injury or damage that is caused by a lack of oxygen to the brain. It is an extremely dangerous condition that requires immediate medical attention. In some instances, cooling therapy may be necessary following birth in order to reverse the effects of oxygen deprivation.

In some instances, HIE can lead to cerebral palsy or other associated disabilities in children. Birth asphyxia, or oxygen deprivation, is believed to cause approximately 840,000 neonatal deaths globally. Cerebral palsy is one of the most serious and costly neurological disabilities due to its prevalence (2 out of every 1,000 births according to the U.S. National Library of Medicine National Institutes of Health), and its persistence over the child’s lifetime.

According to the Florida Neonatal Neurologic Network, hypoxic-ischemic encephalopathy affects approximately 20 out of every 1,000 full-term births. The prevalence is higher in babies born prematurely.

How Does Oxygen Deprivation Occur?

There are a number of causes that can lead to oxygen deprivation and they may occur prior to, during, or after a baby is born. The most common cause of hypoxic ischemic injury is intrauterine asphyxia that develops due to circulatory problems.

Some of the causes may include:

  • Preeclampsia, or high blood pressure
  • Cardiovascular disease
  • Maternal diabetes with vascular disease
  • Severe fetal anemia
  • Lung malformation
  • Very low maternal blood pressure
  • Umbilical cord accidents or issues
  • Prolonged late stages of labor
  • Abnormal fetal position
  • Severe cardiac or pulmonary disease
  • Infections
  • Severe prematurity
  • Low neonatal blood pressure
  • Brain or skull trauma
  • Congenital brain malformations

What Are the Symptoms of hypoxic ischemic encephalopathy?

Some of the symptoms associated with this brain injury include:

  • Poor feeding
  • Behavioral abnormalities
  • Lethargy
  • Seizures and/or epileptic activity
  • Abnormalities or irregularities in heart rate and blood pressure
  • Poor muscle tone, also referred to as hypotonia
  • Labored breathing or no breathing at birth
  • Discoloration at birth, such as a bluish or pale skin tone
  • Excessive acid in the blood
  • Presence of meconium in the amniotic fluid

Are There Available Treatment Options for HIE?

There are several treatment options available for babies born with HIE, such as mechanical ventilation that assists with a baby’s breathing, cooling therapy to reverse brain hypoxia, hyperbaric oxygen treatment, medications, and various treatments to assist the baby’s heart function and control blood pressure.

What is “Cooling Therapy?”

By cooling babies at a temperature lower than their natural body temperature following oxygen deprivation, you may be able to increase their chances of growing up without disabilities, such as cerebral palsy.

Until recently there have not been any approved treatments to help reduce the side effects of low oxygen, or asphyxia, at birth. According to a study quoted in the New England Journal of Medicine, a 2009 study of more than 300 newborns showed that cooling treatment – cooling the infant at 33 degrees Celsius – could help reduce brain damage.

Researchers believe that the cooling therapy may be effective as it can slow the production of harmful substances in the brain as well as the rate of brain cell death.

How is hypoxic ischemic encephalopathy diagnosed?

The guidelines from the American Academy of Pediatrics and the American College of Obstetrics and Gynecology indicate that the following must be present or have occurred for perinatal asphyxia to be designated as severe enough to result in brain damage:

  • pH less than 7 in an umbilical artery blood sample
  • Apgar scores between 0 and 3 for longer than 5 minutes
  • Neonatal neurologic abnormal condition (e.g., coma, seizures, poor muscle tone)
  • Involvement of multiple organs, such as the heart, liver, lungs, and intestines

If your child has suffered from hypoxic ischemic encephalopathy, you should speak with an experienced birth injury attorney immediately to discuss your legal rights. If your child has suffered an injury due to the medical negligence of a health care professional or facility, you may be eligible for compensation to allow you to take better care of your child in need.

Related Resources

Infant Hypoxic Ischemic Encephalopathy (HIE)

Child Skipping Developmental Milestones