Hypoxic-Ischemic Encephalopathy (HIE)

Hypoxic-ischemic encephalopathy (HIE) is a permanent neonatal brain injury caused by oxygen deprivation and/or limited blood flow to the brain at or near the time of birth. When this happens, brain cells die off in a cascade reaction, causing widespread damage. Hypoxic-ischemic encephalopathy is preventable in the vast majority of cases. Doctors may limit the long-term damage caused by HIE by performing hypothermia treatment (also known as ‘therapeutic hypothermia’ or ‘brain cooling’). If doctors suspect that a baby has HIE, it is mandatory that they provide hypothermia treatment. Other terms for HIE are perinatal asphyxia, birth asphyxia, intrapartum asphyxia, and neonatal encephalopathy.

Hypoxic Ischemic Encephalopathy (HIE)

What Is Hypoxic-Ischemic Encephalopathy (HIE)?

(HIE) Hypoxic Ischemic Encephalopathy Definition | Infographic

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Hypoxic-ischemic encephalopathy is a newborn brain injury caused by oxygen deprivation to the brain around the time of delivery. HIE is estimated to occur in about two to nine per 1,000 live births, making it the most common type of neonatal encephalopathy (NE). Neonatal encephalopathy is a broad term used to describe any disturbed neurological function in a newborn baby.

Roughly 10 to 60 percent of babies with HIE die in the newborn period. At least 25 percent of babies with HIE that survive go on to live with significant brain damage and long-term neurodevelopmental impairments.

Lack of oxygen and subsequent cell death (brain damage) can result in mental and physical disabilities such as developmental delays, learning disabilities, cerebral palsy (CP), and seizures.

For babies with HIE, the seriousness of the brain damage depends on the following conditions:

  • The severity of the oxygen deprivation
  • The length of time that the baby was deprived of oxygen
  • The condition of the baby prior to the oxygen deprivation
  • The management of the baby by the medical team after the oxygen-depriving event occurred

Generally speaking, the longer an infant goes without oxygen or with insufficient oxygen, the more severe and permanent the injury will be.

Breaking Down ‘Hypoxic-Ischemic Encephalopathy’: What is a Hypoxic-Ischemic Brain Injury?

A hypoxic-ischemic brain injury is a brain injury caused by a lack of oxygen (hypoxia) and a lack of blood flow (ischemia) to the brain. This can happen due to multiple factors. In adults, this could be because of a stroke, heart attack, or trauma to the head. In babies, this can be due to problems during pregnancy, labor, and delivery, or shortly after birth. See “Causes of Hypoxic-Ischemic Encephalopathy (HIE) and Birth Asphyxia” for more information.

Frequently Asked Question: How Long Can a Baby Survive Without Oxygen?

The questions about how long an unborn baby can survive without oxygen is a complex one. First, there is the distinction between survival with adverse health effects (such as brain damage) versus survival without adverse health effects. Fetuses typically die after 25 minutes without oxygen. In cases of complete oxygen loss (such as with complete cord occlusion, complete abruption, massive blood loss, or fixed fetal bradycardia), the baby should be delivered within 5 minutes, and no longer than 15 minutes. In cases of uterine rupture, researchers found that babies had significant medical problems when more than 18 minutes passed between the onset of prolonged heart rate deceleration and delivery. In many cases, for the baby to survive with the best outcomes, C-sections should be done within 10-18 minutes, and in some cases fewer.

Frequently Asked Question: Can Hypoxia Cause Seizures?

Hypoxia can cause seizures. When the brain is deprived of oxygen, it means that brain cells are deprived of one of the key components they need to be able to function. When these cells die, the complex connections that help different parts of the brain communicate are disrupted. This can result in seizures, which are abnormal electrical discharges in the brain.

Visualizing HIE and Neonatal Brain Injury

HIE and Diminished Blood Flow

Hypoxic Ischemic Encephalopathy (HIE), Birth Asphyxia, Neonatal Encephalopathy

Terms and Definitions for HIE

Understanding HIE - Hypoxic Ischemic Encephalopathy Core Terms - Infographic

Causes of Hypoxic-Ischemic Encephalopathy (HIE) and Birth Asphyxia

A number of complications and medical mistakes can cause hypoxic-ischemic encephalopathy. Causes of hypoxic-ischemic encephalopathy include:

Signs and Symptoms of Hypoxic-Ischemic Encephalopathy

Signs of hypoxic-ischemic encephalopathy (HIE) at birth may include the following:

  • Resuscitation of the newborn at birth
  • Low APGAR Scores for longer than 5 minutes. An APGAR score assesses the overall health of a newborn over the first few minutes of life. It assigns scores to conditions such as the baby’s skin color and complexion, pulse rate, reflexes, muscle tone, and breathing.
  • Seizures within the first 24 to 48 hours after delivery
  • Difficulty feeding, including the inability to latch, suck, or swallow
  • Profound metabolic or mixed acidemia in an umbilical artery blood sample (the baby’s blood is acidic/has a low ph)
  • Hypotonia (low muscle tone)
  • Abnormal limpness
  • Multiple organ problems (e.g., the involvement of the lungs, liver, heart, intestines)
  • No brain stem reflexes (e.g., breathing problems and an abnormal response to light, and only blood pressure and heart function reflexes are functioning)
  • Coma

Diagnosing Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy is confirmed through tests and neuroimaging studies, including the following:

  • CT scans
  • PET scans
  • MRIs
  • Blood glucose tests
  • Arterial blood gas tests
  • EEGs
  • Ultrasounds

In order to perform these tests, doctors must first suspect that a hypoxic-ischemic event occurred. If delivery was traumatic, oxygen-depriving complications occurred, or signs for HIE are present in the baby, medical professionals should begin the diagnostic process. Sometimes, however, signs of brain damage and HIE may not appear until later when a child exhibits impaired motor function, delayed growth and delayed developmental milestones.

HIE can cause numerous health conditions, including:

Treatment for Hypoxic-Ischemic Encephalopathy (Birth Asphyxia)

HIE Treatment Before the Advent of Hypothermia Therapy

Traditionally, babies with HIE have been treated with supportive care to limit brain damage and prevent further injury. Specifically, HIE treatment has included conventional measures such as ventilation, NICU care, controlling or preventing seizures, maintaining blood glucose and blood pressure, minimizing cerebral swelling, and receiving care from specialty physicians.

Treating HIE Today: Hypothermia Therapy  (Brain Cooling)

Recently, a new treatment for HIE called hypothermia treatment (also known as brain cooling) has been introduced specifically for the treatment of hypoxic-ischemic encephalopathy. Hypothermia treatment has shown promising results in improving the outcome of babies with birth-associated HIE by reducing the severity of neurological injury.

The treatment consists of lowering a newborn’s body temperature to around 91 degrees Fahrenheit for a period of about 72 hours. Lowering the baby’s temperature slows the metabolic rate, allowing cells to recover over a longer period of time. This avoids further damage that can occur if normal oxygenation or blood flow is restored too quickly to injured cells. Once hypoxic-ischemic encephalopathy is diagnosed, it is critical that hypothermia treatment begins, as long as all indications for the treatment are met. Failure to perform hypothermia treatment on a newborn baby who is eligible and in need of the treatment is an instance of medical malpractice.

Therapeutic Hypothermia - Body Cooling for Babies with Hypoxic-Ischemic Encephalopathy (HIE)

Preventing HIE (Hypoxic-Ischemic Encephalopathy)

Prevention of birth asphyxia and HIE (hypoxic-ischemic encephalopathy) boils down to two major factors:

  1. Closely monitoring the mother and baby so that fetal distress or impending distress is recognized
  2. Quickly delivering the baby when fetal distress or impending distress are present.

During pregnancy, the mother and baby should have regular prenatal tests to help ensure fetal health. If the pregnancy is high risk, more frequent prenatal testing is required and the mother should be referred to a maternal-fetal specialist. As soon as the mother is admitted to the labor and delivery unit, a fetal heart monitor should be attached to her body and the baby’s heart rate should be continuously monitored.

In addition, the mother should be monitored for any signs of a pregnancy complication, such as a nuchal cord or placental abruption. If these or other complications exist, preparation for a C-section delivery should be made, in most cases. The point of a fetal heart monitor is to alert the medical team of fetal distress. If the baby is experiencing a lack of oxygen to her brain, this will result in nonreassuring heart tracings on the fetal monitor. When nonreassuring tracings occur, the medical team may try resuscitative maneuvers which are aimed at increasing blood flow and oxygen to the baby. These maneuvers may include IV fluids or giving oxygen to the mother. However, there is no guarantee that resuscitative maneuvers will relieve fetal distress. In fact, distress caused by certain obstetrical conditions, such as a complete cord compression or complete placental abruption will not be affected by in-utero resuscitation; babies experiencing these conditions must be delivered within a matter of minutes.

When fetal distress occurs, preparations should be made for a prompt C-section delivery while in-utero resuscitation maneuvers are being undertaken. It is very important to have skilled members of the healthcare team involved in labor and delivery. It takes skill to interpret fetal heart tracings, and these tracings are often the only indication that a baby is experiencing birth asphyxia and HIE. The team also must be well-coordinated so that preparations and execution of a C-section delivery are fast. A delay in performing a necessary C-section can cause hypoxic-ischemic encephalopathy and permanent brain damage in the baby.

How Do You Pronounce Hypoxic-Ischemic Encephalopathy?

Video: Our Michigan Hypoxic-Ischemic Encephalopathy Lawyers Discuss HIE

In this video, hypoxic-ischemic encephalopathy lawyers Jesse Reiter and Rebecca Walsh discuss the causes of and treatments for HIE.  Negligence by the medical team is often the cause of HIE and birth asphyxia.

Hypoxic-Ischemic Encephalopathy Lawyers | Legal Help for Children with HIE and Birth Injuries

HIE cases require specific, extensive knowledge of both law and medicine. For the best case outcomes, it’s critical to find an attorney and a law firm that focus specifically on hypoxic-ischemic encephalopathy cases. At Reiter & Walsh, P.C., our hypoxic-ischemic encephalopathy lawyers have been focusing their careers on birth injury and HIE cases, and they consistently secure multi-million dollar settlements for their clients.

Reiter & Walsh ABC Law Centers is based in Michigan, but we handle cases throughout the United States. For instance, we handle hypoxic-ischemic encephalopathy cases in Michigan, Ohio, Washington D.C., Pennsylvania, Tennessee, Arkansas, Mississippi, Texas, Wisconsin, and all other states in the U.S. Our birth injury team is also equipped to handle cases involving military medical malpractice and federally-funded clinics.

Phil Review of Reiter and Walsh

Contact Reiter & Walsh, P.C. today to begin your free case review with our Detroit, Michigan hypoxic-ischemic encephalopathy lawyers. Free of charge and obligations, we will answer your legal questions, determine the negligent party, and inform you of your legal options. Our team is available to speak with you to set up an appointment in any of the following ways:

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Related Reading from Our Hypoxic-Ischemic Encephalopathy Lawyers

  • Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy. Obstet Gynecol 2014; 123:896.
  • Wu YW, Backstrand KH, Zhao S, et al. Declining diagnosis of birth asphyxia in California: 1991-2000. Pediatrics 2004; 114:1584.
  • Graham EM, Ruis KA, Hartman AL, et al. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008; 199:587.
  • Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: incidence, clinical course and outcome in a Swedish population. Acta Paediatr 1995; 84:927.
  • Lee AC, Kozuki N, Blencowe H, et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res 2013; 74 Suppl 1:50.
  • Barnette AR, Horbar JD, Soll RF, et al. Neuroimaging in the evaluation of neonatal encephalopathy. Pediatrics 2014; 133:e1508.
  • Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33:696.
  • Ferriero DM. Neonatal brain injury. N Engl J Med 2004; 351:1985.
  • Dammann O, Ferriero D, Gressens P. Neonatal encephalopathy or hypoxic-ischemic encephalopathy? Appropriate terminology matters. Pediatr Res 2011; 70:1.
  • Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy. Obstet Gynecol 2014; 123:896.
  • Sartwelle TP. Defending a neurologic birth injury. Asphyxia neonatorum redux. J Leg Med 2009; 30:181.
  • Badawi N, Kurinczuk JJ, Keogh JM, et al. Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317:1549.