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Neonatal Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy, or HIE, is the brain injury caused by oxygen deprivation to the brain. HIE is triggered by a combination of an interruption of oxygen circulation, called hypoxia, and ischemia, which refers to blood flow restriction.

Hypoxic-Ischemic Encephalopathy, or HIE, is a birth injury caused by sustained oxygen deprivation and limited blood flow to the brain at birth. The longer the brain goes without oxygen and blood, the greater the potential for long-term damage and disability. Also known as birth asphyxia and neonatal encephalopathy, HIE affects between one and two babies per 1,000 born annually.

If your child suffered Hypoxic-Ischemic Encephalopathy at birth, it’s important to consider your legal rights and options. Many times, HIE is a birth injury caused by medical negligence. In these situations, you and your family may have the right to file a birth injury lawsuit and demand compensation from the doctor, hospital, and insurance company.

An HIE lawyer at The Birth Injury Center can help you fight for financial accountability if your child struggles with debilitating injuries caused by HIE. Contact us to discuss the details of your child’s birth injury case today.

Infant sleeping

What is Hypoxic-Ischemic Encephalopathy?

Hypoxic-Ischemic Encephalopathy is a severe birth complication that affects preterm and full-term infants, and 40 to 60 percent of affected infants either die by age two or have severe disabilities.

  • Hypoxic refers to oxygen deprivation in the brain
  • Ischemic refers to reduced blood flow to the brain, and
  • Encephalopathy refers to resulting brain damage

According to a study published by the Journal of Biomedicine and Biotechnology, of those who suffer perinatal HIE, 25 percent of surviving infants will develop severe and permanent neuropsychological consequences, “including mental retardation, visual motor or perceptive visual dysfunction, increased hyperactivity, cerebral palsy, and epilepsy.”

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25 percent of surviving infants will develop severe and permanent neuropsychological consequences.

What Causes Hypoxic Ischemic Encephalopathy?

HIE occurs when the brain is deprived of oxygen. A variety of factors can lead to HIE. HIE can occur during fetal development, labor, and delivery or during the postnatal period.

Causes of HIE during fetal development can include:

  • Preeclampsia
  • Maternal diabetes
  • Vascular disease
  • Uterine rupture
  • Placental abruption
  • Fetal infection
  • Fetal anemia
  • Fetal lung malformation
  • Maternal drug and alcohol use

Causes of HIE during labor and delivery can include:

  • Umbilical cord prolapse
  • Umbilical cord compression
  • Placental abruption
  • Failure to monitor the child’s heartbeat
  • Breech presentation
  • Shoulder dystocia
  • Fetal stroke
  • Delivery complications
  • Failure to perform a timely C-Section

Causes of HIE during the postnatal period can include:

  • Lung or heart disease
  • Infection
  • Brain or skull trauma
  • Low blood pressure
  • Respiratory failure
  • Hypoglycemia
  • Hyperglycemia

HIE often occurs when health care providers miss important signs and symptoms of the injury or make critical mistakes during pre and post-natal care.

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HIE occurs in one to two infants per thousand

What Are the Stages of HIE?

HIE has three stages, and its symptoms depend upon the stage and the areas of the brain affected. The seriousness of a baby’s condition and the lifelong complications depend upon several factors. These include the following:

  1. The length of time the baby was without oxygen
  2. The baby’s birth weight and overall health
  3. The speed and efficiency of treatment

Stage 1 - Mild HIE

The first stage is mild hypoxic-ischemic encephalopathy. Mild HIE typically resolves itself within 24 hours to a few days without any long-lasting effects.

In mild HIE, the baby is stiff and seems hyper-alert. Deep tendon reflexes might be brisk, and muscle tone slightly decreased. Alternatively, the baby may be floppy and unreactive to sights or sounds.

The baby may also exhibit behavioral abnormalities such as irritability, poor feeding, excessive crying, or sleepiness, often in an alternating pattern.

Stage 2 - Moderate HIE

The second stage is moderate HIE. With moderate HIE, the infant is lethargic and may have sluggish—or nonexistent—sucking and grasping reflexes and may experience apnea and seizures within the first 24 hours after birth.

The outcome of stage 2 HIE is highly variable. Some infants with moderate HIE will recover completely within a few weeks. However, others may experience permanent consequences.

Stage 3 - Severe HIE

The third stage is severe HIE. A stupor or coma is typical in this stage, and the infant may fail to respond to physical stimuli. Breathing may be irregular, and the infant may require a ventilator. They may experience extreme hypotonia, or decreased muscle tone.

In addition, the infant may lack reflexes such as sucking, swallowing, or grasping and demonstrate eye motion disturbances and dilated pupils. Infants with severe HIE may experience delayed and severe seizures that resist conventional treatments. They may also have heart rate and blood pressure irregularities. Cardiorespiratory failure, often fatal, can occur.

HIE Diagnosis

Doctors can make an HIE diagnosis by analyzing a child’s symptoms and utilizing several different diagnostic tests, including:

  • Magnetic Resonance Imaging: An MRI can be performed four to seven days after birth to identify parts of the brain that may have been damaged by HIE.
  • Electroencephalogram: An EEG can be performed on the first day of life and reveal electrical activity in the brain. Abnormalities in electrical signals can indicate HIE.
  • Monitor Cord Blood Gas Levels: Low fetal oxygen levels can be identified by testing gas levels in cord blood samples.
  • Infant Blood Tests: Oxygen levels can also be detected by directly testing the infant’s blood.
  • Ultrasound: Swelling or bleeding in the brain can be diagnosed using an Ultrasound.
  • Lumbar Puncture: Cerebral spinal fluid collected during a lumbar puncture can give insight into any infections in the brain, which can be indicative of HIE.

HIE can be diagnosed when a child is an infant or later in life, depending on when symptoms become apparent. If you notice your child struggling with cognitive function or motor development, tell your doctor about any trauma they may have had at birth. Your doctor can run tests to confirm or rule out an HIE diagnosis.

Effects of HIE

The long-term effects of hypoxic-ischemic encephalopathy can be severe and result in permanent health problems.

  • Disability. Common disabilities associated with HIE include mental retardation, epilepsy, cognitive problems, developmental and motor-skill delays, and cerebral palsy. It’s estimated that as many as 80 percent of infants who survive severe HIE develop serious complications.
  • Developmental Delays. Delays occur when a child misses a physical, mental, or emotional milestone or falls behind their peers.
  • Cerebral Palsy. Cerebral palsy is a group of disorders that affect a person’s ability to move, maintain balance and posture, or speak.
  • Epilepsy. HIE is one of the most frequent causes of epilepsy, a chronic disorder characterized by unpredictable seizures and other health problems. About 3.4 million people have epilepsy—470,000 of which are children. Epilepsy is a spectrum condition with many seizure types that vary from person to person. Seizures can affect a person’s work and relationships.
  • Vision Loss. Oxygen deprivation is a common cause of cortical vision impairment, which refers to damage to the portion of the brain that processes vision. It can cause tunnel vision or strabismus, a condition in which the eyes are misaligned and point in opposite directions.
  • Hearing Loss. Babies with HIE are at a higher risk of sensorineural hearing loss, which occurs when the inner ear is damaged or if pathways between the brain and inner ear are damaged. It can be temporary or permanent. If sensorineural hearing loss is permanent, audiologists can treat it with hearing aids or cochlear implants.
  • Cognitive Dysfunction. HIE can affect cognitive development, memory, and activity. The more severe the HIE, the more severe the cognitive impairment. Infants with severe HIE have an increased risk of mental retardation. Cognitive impairment can impact the ability to learn, make decisions, and interact socially.
  • Organ Damage and Failure. In infants who survive severe HIE, the heart is affected 43 to 78 percent of the time, the lungs are affected 71 to 86 percent of the time, the renal system is affected 46 to 72 percent of the time, and the liver is affected 80 to 85 percent of the time.
  • Motor-Skill Developmental Delays. HIE can be a key factor in delays in motor-skill development. These delays may be related to HIE-induced cerebral palsy, epilepsy, or other conditions. Parents typically notice these delays when their child misses certain developmental milestones.
  • Death and Severe Impairment. Multiple peer-reviewed studies have noted that by age 2, “up to 60 percent of infants with HIE will die or have severe disabilities.”

Prevention and early treatment are essential for limiting or preventing potential complications and long-term health issues associated with HIE.

HIE Life Expectancy

Hypoxic Ischemic Encephalopathy will affect different children in different ways. Some children will not exhibit many—if any—symptoms and live a normal life. Others will suffer catastrophic, permanent brain damage that drastically shortens their life expectancy.

As a result, HIE’s impact on a child’s life expectancy ultimately depends on the location of the brain damage, the extent of the injury, the length of time the child was deprived of oxygen, and the promptness and effectiveness of medical treatment provided. Research suggests an early brain MRI can predict life expectancy and major health outcomes.

In some situations, HIE can cause a child’s death within hours or days. Other times, a child’s life expectancy can be unaffected by their birth injury.

Treatment for HIE

Diagnosing HIE early is vital because it can be treated. Timely treatment can lessen the severity of the condition. Short-term treatment often includes therapeutic hypothermia for 72 hours, a ventilator, and medications to treat seizures, heart rate, and blood pressure.

Therapeutic Hypothermia

Therapeutic hypothermia, also called ‘cooling’ or ‘brain cooling,’ is provided in some hospital neonatal intensive care units and involves lowering a newborn’s body temperature to about 93 degrees for 72 hours.

Hypothermia treatment has been shown to improve outcomes in people with neurological injuries, including newborns.

Researchers still aren’t quite sure why lowering body temperature is beneficial, but the current theory is that a lower core temperature slows biological processes, meaning that tissue damage also occurs more slowly. After hypothermia treatment, doctors gradually rewarm the infant to normal body temperature.

Early diagnosis of HIE is critical to preventing long-term effects of HIE and reducing the risk of severe disability and death. Therapeutic hypothermia must be initiated within 6 hours of birth in order to be effective. 

High-Frequency Ventilation and Extracorporeal Membrane Oxygenation

According to Seattle Children’s Hospital, doctors may use other treatment options, such as high-frequency ventilation, which sends small puffs of air into the child’s lungs. Babies with respiratory failure may receive nitric oxide through a breathing tube to open the blood vessels in their lungs so that the vessels can carry oxygen-rich blood around the body. Doctors sometimes use extracorporeal membrane oxygenation, which uses a machine outside the body to add oxygen to the baby’s blood.

Medication and Therapies

Long-term treatments are meant to help the child adapt to the symptoms caused by the brain injury and depend upon the severity of the diagnosis. These include seizure medications and therapies to support the heart and maintain healthy blood pressure functioning, dialysis, and physical and occupational therapy.

Be a Champion For Your Child

Parents of children with brain injuries can enhance their children’s quality of life by consulting with a medical team and following their doctors’ advice, being open to various treatment options, and taking an active role in physical and occupational therapy settings.

Finally, parents can help their children set realistic and achievable goals and celebrate their accomplishments with them. And they can offer encouragement and constructive advice for meeting unmet goals.

Many children with special needs thrive with a routine, and parents can be instrumental in establishing that routine. It’s important that parents pay attention to their own wellness, too—seeking support and counseling if needed.

Caring for a child with a birth injury can be taxing and expensive. You may need to take considerable time off work, hire a special caregiver, or quit your job entirely. You may have to spend considerable money on treatments, therapies, and education. No two injuries or children are the same. Finding the right option for your child is critical.

Is HIE Associated With Medical Malpractice?

 Oxygen deprivation—and resulting HIE—often results directly from medical malpractice.

Doctor and health care provider mistakes that can cause fetal oxygen deprivation include the following:

  • Failure to monitor before, during, and after labor
  • Misuse of surgical tools, including vacuums and forceps
  • Failure to identify a serious infection in the mother or child
  • Premature separation of the placenta from the uterus
  • Failure to order a timely C-Section

Many times, doctors miss important signs of fetal distress and, as a result, allow babies to go without oxygen for extended periods. Additionally, if signs, symptoms or risk factors for HIE are missed or ignored by medical professionals in immediate neonatal period and early interventions are not done, HIE may result in neonatal death or severe disabilities which could have otherwise been prevented. Sometimes, this is because the doctor refuses to listen to a mother’s concerns, fails to order necessary tests, or delegates important responsibilities to less-experienced practitioners or students.

Medical professionals are legally obligated to provide a certain level of care for their patients. When a doctor’s care falls below accepted standards, they can be considered negligent and held legally responsible for a child’s resulting HIE diagnosis, birth injury, or death.

Next Steps

If your child has been diagnosed with Hypoxic Ischemic Encephalopathy, you’re not alone. Every year, thousands of families nationwide struggle with the consequences of this often-debilitating and traumatic birth injury.

Fortunately, plenty of tools and resources are available to you and your family as you care for your child, including the following:

If your child has suffered a secondary condition related to HIE, such as Cerebral Palsy, there are hundreds of support groups and organizations dedicated to providing help and assistance in your journey. Notable resources include the CPNow Foundation, CP Daily Living, United Cerebral Palsy, the Family Advocate Network, and The Arc.

If your child’s HIE results from a medical professional’s negligence, you need not bear the burden of their birth injury alone. You have the legal right to file a medical malpractice lawsuit and demand that the negligent health care provider is held fully accountable for your child’s injury, suffering, and costs.

Hiring an attorney can be one of the most important steps in recovering compensation for HIE. The Birth Injury Center has a passionate group of birth injury attorneys, health care providers with extensive experience in prenatal complications and birth trauma, and families of children who have suffered devastating birth injuries. We offer the compassionate assistance you need during this difficult time and the resources and experience needed to help you win your Hypoxic Ischemic Encephalopathy lawsuit.

You only have a limited time to file a birth injury lawsuit for HIE, so contact us to get answers to your most pressing birth injury lawsuit questions, discuss specific details of your child’s HIE case, and discover how we can help you make the most of your fight for compensation. Your initial case evaluation is free.

Written by:
Birth Injury Center Team

The Birth Injury Center aims to create informational web content and guides to help women and their families seeking support and guidance for birth injuries caused by medical negligence. All of the content published across The Birth Injury Center website has been thoroughly investigated and approved by medical expert Natalie Speer, RNC-OB, Attorney Ryan Mahoney, and Attorney Rick Meadows.