How Is Hypoxic-Ischemic Encephalopathy (HIE) Diagnosed?

Hypoxic-ischemic encephalopathy is a brain injury that is diagnosed when a baby does not get enough oxygen, usually during labor and delivery. The diagnosis is made using a combination of tests, including physical and neurological exams, lab results, and brain imaging. These tests are used to measure the timing and severity of the baby’s brain injury and to check for possible organ damage.

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Diagnosing HIE In Babies

Hypoxic-ischemic encephalopathy (HIE) can be caused by different complications during or shortly after birth that deprive the baby of oxygen. There are various signs that a baby may have suffered from HIE, including:

  • Neonatal seizures
  • Brain injury seen on MRI
  • Low APGAR scores (evaluation of a newborn baby’s activity, pulse, grimace, appearance, and respiration)
  • The baby’s blood is acidic
  • Multiple organ failure
  • Signs of fetal distress on fetal monitoring

A baby with HIE may be lethargic, have difficulty breathing or feeding, and/or exhibit abnormal movements at or shortly after birth. While the severity of these signs can vary, a baby diagnosed with HIE typically requires resuscitation after birth. A baby with severe HIE likely will be taken to the neonatal intensive care unit (NICU) for critical treatment.

a baby with a heart shaped piece of gauze on one cheek

Neonatal Evaluation

In order to diagnose a baby with HIE, the American College of Obstetricians and Gynecologists (ACOG) recommends completing a comprehensive evaluation of the baby’s status at or shortly after birth. In addition, they recommend that physicians also evaluate the mother’s medical history, pregnancy, the labor period, and placental pathology.

There are multiple different tests and studies that medical staff may conduct once they suspect that a baby has HIE.

  • Magnetic Resonance Imaging (MRI) scan: This test uses magnetic waves to make pictures of structures inside the baby’s brain. Repeat imaging studies can show the progression of a brain injury. When a baby suffers HIE, the brain injury can change over days and even weeks.
    • MRI studies can locate where brain injury occurred and how long it lasted. Using MRI to help diagnose a baby’s HIE brain injury is considered the standard of care in the United MRI machine
  • Umbilical cord blood samples: Umbilical cord blood gas can be instrumental to diagnose hypoxic-ischemic encephalopathy and its cause. The umbilical cord passes nutrients and oxygen-rich blood from the mom to the baby in the womb. Umbilical blood gas tests can show if this flow of oxygen and nutrients was interrupted.. If a baby does not get enough oxygen, they can suffer from HIE and cord gasses will usually reflect this. 
  • A complete blood count: These laboratory tests can determine if a hemorrhage occurred, whether the baby had a low platelet count, or an infection. A bacterial blood culture is also taken to rule out certain infections, like sepsis.
  • Lumbar puncture: If   infection is suspected, a lumbar puncture can be performed and antibiotics will be administered until an infection is ruled out.
  • Electroencephalogram (EEG): This test records the activity of a baby’s brain by measuring electrical currents through the brain. An EEG will help identify seizures and determine their cause. HIE is one of the most common causes of neonatal seizures. Unfortunately, seizures can worsen the existing brain injury.
  • Cranial ultrasound: This imaging study is non-invasive. While ultrasounds can provide useful information to diagnose a brain injury, an MRI provides more detailed and accurate information for diagnosis.

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Importance of Diagnosing HIE Early

Hypoxic-ischemic encephalopathy is a serious brain injury. If not treated immediately within 6 hours of birth, the prognosis for an HIE brain injury is usually worse. However, when physicians quickly diagnose a newborn baby with HIE, they can intervene in time. Timely diagnosis and treatment is critical in order to help the baby and improve their prognosis.

Therapeutic hypothermia, also known as brain or body cooling, is a cooling treatment for HIE that can reduce the chance of death or extent of brain injury. Research also shows that when cooling therapy is done within six hours of the time that the baby suffers HIE, it can reduce the chance and extent of permanent disability. 

Why Was My Baby Diagnosed With HIE?

Unfortunately, there are many conditions and complications during labor and delivery that can result in a baby’s HIE. If you had a difficult labor and delivery, or your child had to be admitted to the NICU and suffered shortly after birth, you understandably may be questioning what went wrong.

Medical negligence during pregnancy, labor, delivery, or even after delivery can lead to a baby suffering from HIE. While some pregnancy complications and conditions cannot be prevented, it’s critical for medical staff to appropriately monitor each patient, discuss and understand their individual risk factors, and intervene if anything goes wrong. All medical staff must follow standards of care.

If medical staff and hospital systems neglect to follow standards of care or they make an error that leads to a baby being diagnosed with HIE, that is considered medical malpractice. If you suspect that your baby’s HIE is due to medical negligence, it’s important to consider contacting a lawyer to understand your legal options.

How Can An HIE Lawyer Help?

Hypoxic-ischemic encephalopathy (HIE) lawyers are experienced in cases of medical negligence involving HIE, cerebral palsy, and other associated injuries or disabilities. Due to the complex nature of the medical and legal knowledge required to pursue these cases, it’s critical to contact a lawyer that is experienced in HIE and birth injury cases.

Our HIE lawyers see how difficult it can be for parents to digest the news of an HIE diagnosis and often scary prognosis. Many of our clients require 24/7 care and special treatments. The emotional, physical, and financial toll from learning your child has HIE and it could have been prevented can feel insurmountable. That’s why our team is committed to helping you obtain justice for your child and secure their care for life.

At ABC Law Centers, birth injury is all we do. HIE is diagnosed in the majority of our cases. Since 1997, our staff has advocated and fought passionately for children with disabilities from HIE and other birth injuries. We have a network of leading medical experts that we consult with, and dozens of multi-million dollar verdicts and settlements for the brave families whom we’ve worked with.

"Throughout the process, the team showed unwavering commitment and kindness, keeping us informed and involved every step of the way." -Elizabeth Cademas

We know that parents have many questions and may feel intimidated by the idea of suing their doctor or hospital. Rest assured, a consultation with us is completely free and you are under no obligation to work with us. In fact, our clients do not pay anything unless we obtain a favorable settlement or verdict. Contact us today to learn whether you may have a case. 

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Video: Hypoxic Ischemic Encephalopathy (HIE) from Pregnancy, Labor, Delivery and Neonatal Injuries

In this video, birth injury lawyers Jesse Reiter and Rebecca Walsh discuss the causes of and treatments for HIE.

 More Information On HIE


  1. Clinical features, diagnosis, and treatment of neonatal encephalopathy – UpToDate
  2. Whole Body Cooling for Infants with Hypoxic-Ischemic Encephalopathy – PMC 
  3. Executive Summary: Neonatal Encephalopathy and Neurologic Outcome, Second Edition 
  4. Clinical features, evaluation, and diagnosis of neonatal seizures – UpToDate