Mild Hypoxic Ischemic Encephalopathy

Babies that don’t receive enough oxygen around the time of labor and delivery risk developing a dangerous brain injury called hypoxic ischemic encephalopathy (HIE). HIE is caused by decreased blood flow and oxygen in the brain. HIE can cause permanent brain damage, leaving a child with lifelong conditions, such as seizures, cerebral palsy (CP), developmental disabilities and motor disorders.

A new study found that even mild hypoxic-ischemic encephalopathy can cause long-term problems in a child, such as intellectual disabilities, developmental delays, learning disorders, behavioral difficulties, speech delays, autism, attention deficit disorder and dyspraxia (1). This research is significant to note because there is only one treatment for HIE, and if a child is diagnosed with a mild form of HIE, they usually will not qualify for the critical treatment. The treatment is hypothermia, or brain cooling, and it must be given within 6 hours of the time the baby was deprived of oxygen. This usually means the treatment must be given within 6 hours of delivery (2). Hypothermia treatment for HIE has been shown to stop almost every injurious process that starts to occur when the brain experiences a lack of  oxygen. The treatment can significantly decrease the likelihood that HIE will cause permanent brain damage, which may prevent a child from developing CP, or it may reduce the severity of the CP.

Causes of Mild HIE

Hypoxic ischemic encephalopathy (HIE) is the most common type of birth injury. It is often caused by oxygen deprivation (birth asphyxia) that occurs during or near the time of birth. During labor and delivery, problems with the umbilical cord, placenta or uterus can cause birth asphyxia. Listed below are conditions that can occur during or near the time of birth that can lead to HIE

Requirements for hypothermia treatment

Many hospitals use criteria from HIE and brain cooling research trials to determine whether a baby is eligible for hypothermia treatment. The eligibility requirements for hypothermia treatment in many hospitals are (1):

  • Gestational age greater than 36 weeks
  • Their pH is less than 7, or base deficit is 16 or greater in umbilical cord arterial blood
  • If pH is 7.01 – 7.15, base deficit is 10 – 15.9, or a blood gas sample is not available, these additional criteria are required:
    • A sudden event during labor such as… 
      • non-reassuring fetal heart tones (late or variable decelerations)
      • umbilical cord prolapse or rupture
      • uterine rupture
      • maternal trauma, hemorrhage or cardio-respiratory arrest 
    • AND either… 
      • a 10 minute Apgar score of 5 or less 
      • OR assisted ventilation (baby is on a breathing machine or is being bagged) at birth that lasts 10 minutes or more
  • Evidence of seizures or neonatal encephalopathy (global brain injury) by a standard neurological exam

Some hospitals use criteria such as the following from the American Academy of Pediatrics in Virginia (3):

  1. Infants greater than 35 weeks gestation with ONE of the following:
  • Apgar score of less than 5 at 10 minutes after birth
  • Continued need for resuscitation, including endotracheal or mask ventilation, at 10 minutes after birth
  • Acidosis defined as either umbilical cord pH or any arterial pH within 60 minutes of birth less than 7.00
  • Base deficit greater than 16 mmol/L in umbilical cord blood sample or any blood sample within 60 minutes of birth (arterial or venous blood)

If the infant meets criteria A then assess for neurological abnormality:

  1. Moderate to severe encephalopathy (Sarnat 2 or 3) consisting of an altered state of consciousness (as shown by lethargy, stupor, or coma) and at least one or more of the following:
  • Hypotonia
  • Abnormal reflexes including oculomotor or pupillary abnormalities
  • Absent or weak suck

Physicians at different hospitals may use varying methods for diagnosis of HIE. The key is for them to recognize the signs, quickly diagnose the condition, and begin hypothermia treatment. If the baby meets the criteria for hypothermia treatment listed above, the therapy should be started right away. Hypothermia treatment is very easy to give and as of yet, researchers have not seen harmful effects of the therapy when it is properly implemented.

Legal help for children with HIE

If you are seeking the help of an HIE attorney, it is very important to choose a lawyer and firm that focus solely on birth injury cases. ABC Law Centers (Reiter & Walsh, P.C.) is a national birth injury law firm that has been helping children with birth injuries for almost three decades.

Attorney Jesse Reiter, president and founder of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve HIE and cerebral palsy. Jesse and firm partner Rebecca Walsh  have been consistently recognized in Best Lawyers for Plaintiffs – Medical Malpractice and Plaintiffs – Personal Injury in Troy, Michigan,  by U.S. News and World Report, which also consistently recognizes ABC Law Centers in Best Law Firms.

Contact our birth injury attorneys and legal nurses in any of the following ways with any questions you may have. We do not charge any fees for our legal processes unless we win!

Free Case Review | Available 24/7 | No Fee Until We Win

Phone (toll-free): 888-419-2229
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Video: Michigan HIE Attorney Discusses Birth Asphyxia and Neonatal Seizures

Watch a video of attorney Jesse Reiter discussing how birth asphyxia can cause HIE, which often results in seizures.  Most neonatal seizures are caused by hypoxic ischemic encephalopathy.



Related Reading


  1. Reiss, J., Sinha, M., Gold, J., Bykowski, J., & Lawrence, S. M. (2019). Outcomes of Infants with Mild Hypoxic Ischemic Encephalopathy Who Did Not Receive Therapeutic Hypothermia. Biomedicine hub, 4(3), 1–9.
  2. Hypothermia Therapy: Treatment for Hypoxic-Ischemic Encephalopathy. (2019, January 28). Retrieved December 18, 2020, from
  3. Olsen, S., DeJonge, M., Kline, A., Liptsen, E., Song, D., Anderson, B., & Mathur, A. (2013, February 01). Optimizing Therapeutic Hypothermia for Neonatal Encephalopathy. Retrieved December 27, 2020, from


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