Hypoxic-Ischemic Encephalopathy (HIE)

Hypoxic-ischemic encephalopathy (also known as birth asphyxia) is a severe and permanent neonatal brain injury. HIE occurs due to 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 brain damage. This kind of injury is preventable in the vast majority of cases. If HIE does occur, doctors can sometimes limit the amount of damage that HIE causes by promptly using hypothermia treatment (also known as ‘therapeutic hypothermia’ or ‘body cooling’) to slow down how quickly damage spreads. This requires that the therapy is administered very quickly after the baby is born. If doctors suspect that a baby has HIE, it is mandatory (required) that they provide hypothermia treatment.

What Is Hypoxic-Ischemic Encephalopathy (HIE)?

(HIE) Hypoxic Ischemic Encephalopathy Definition | Infographic

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Hypoxic-ischemic encephalopathy is the most common type of neonatal encephalopathy (NE), which is a broad term used to describe any disturbed neurological function in a newborn baby. HIE is estimated to occur in about two to nine per 1,000 live births. Roughly 10 to 60 percent of affected infants die in the newborn period and at least 25 percent of those 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 intellectual and developmental disabilities, learning disabilities, cerebral palsy (CP) and seizures. The extent and seriousness of the damage depend 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 medical 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 decreased oxygen, the more severe and permanent the injury will be.

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

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

A number of complications and medical mistakes can cause hypoxic-ischemic encephalopathy. Some of these causes 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 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., 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 hypoxici-schemic 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.

Treatment for Hypoxic-Ischemic Encephalopathy / Birth Asphyxia

Traditional treatment of hypoxic-ischemic encephalopathy has included supportive care to limit brain damage and prevent further injury. Specifically, this meant 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.

Recently, a new therapy 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.

Video: Our Michigan Hypoxic-Ischemic Encephalopathy Lawyers Discuss HIEHypoxic Ischemic Encephalopathy Lawyers | Reiter & Walsh, P.C.

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

Hypoxic Ischemic Encephalopathy (HIE) Attorneys | Reiter & Walsh, PCHIE 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 United States. Our birth injury team is also equipped to handle cases involving military medical malpractice and federally funded clinics.

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.