What is Hypoxic Ischemic Encephalopathy?

Premature newborn baby being treated in intensive care as he is hooked up to an IV and health monitors

If you are reading this page, you may have come here because you were told your child has hypoxic ischemic encephalopathy, and you are looking for information and guidance.

Hypoxic ischemic encephalopathy (HIE) is hard to say, and even harder to hear when your child is being diagnosed with it. HIE is brain damage that occurs when an infant’s brain has not gotten enough oxygen and blood. The oxygen deprivation that causes HIE generally takes place in the perinatal period (shortly before and after birth). Hypoxic means “lack of oxygen.” Ischemic means that blood flow has been restricted. And encephalopathy means that the functioning of the brain has been affected.

HIE is less common in full-term births. Various studies have reported HIE being diagnosed in about as few as two or three in a thousand, and as many as twenty in a thousand, babies born after a full-term pregnancy. HIE is much more common in premature births. If your child has HIE, you are probably wondering what caused it, if anything could have gone differently, and most importantly, what to do next.

What Causes Hypoxic Ischemic Encephalopathy?

HIE can be caused by a number of medical issues before, during, or after birth. HIE may be the result of complications during pregnancy, such as preeclampsia, cardiac disease, or maternal diabetes with vascular complications. Impaired circulation of blood to the placenta can also cause HIE. Fetal issues such as malformed lungs or fetal anemia may also result in this condition.

During labor and delivery, accidents with the umbilical cord, placental abruption, extended late-stage labor, and abnormal positioning of the fetus have been known to cause HIE, as has extremely low maternal blood pressure. HIE may be the result of a birth injury.

Premature infants especially are at risk in the postpartum period, often due to brain or skull trauma, infection, cardiac or lung disease, or very low blood pressure. And sometimes, HIE will be diagnosed without a cause being identified.

How is Hypoxic Ischemic Encephalopathy Diagnosed?

A doctor may consider a diagnosis if an infant exhibits certain symptoms, including:

  • Low heart rate
  • Seizures
  • Slow or depressed breathing
  • Pale or bluish skin
  • Meconium-stained amniotic fluid
  • Acidosis (excessive acid in the blood)
  • Low muscle tone
  • Depressed reflexes

A baby with HIE may have a very low Apgar score (less than 3) lasting for more than five minutes.

If HIE is suspected based on some of the symptoms above, doctors may perform ultrasounds, echocardiograms, electroencephalogram (EEG), electrocardiogram (EKG), CT scans or magnetic resonance imaging (MRI) to get more information. Evoked potential tests may also be used to measure the time it takes the baby’s nerves to respond to stimulation, and the strength of the response.

Prognosis and Treatment for Hypoxic Ischemic Encephalopathy

As with many types of brain injury, symptoms of HIE may be mild, moderate, or severe. Unfortunately, it can be difficult to know the true extent of injury until a child reaches three or four years of age. A child with mild HIE may experience few problems; a child with severe injury may have significant health problems and a shortened lifespan. Common effects of HIE include developmental delays, including delays in neurodevelopment and the development of motor skills, cognitive deficits, and seizure disorders.

There is no cure for HIE, but treatments and therapy given at the right time can help treat symptoms and minimize deficits. A treatment called therapeutic hypothermia (also known as cooling therapy or hypothermia therapy) can minimize brain damage if administered within six hours of the oxygen deprivation, ideally as soon as possible afterward. A cooling cap may be applied to the baby’s head, or whole-body cooling may be recommended. Following therapy of up to three days, the baby is gradually re-warmed to a normal temperature.

Because therapeutic hypothermia is the only therapy known to prevent damage from HIE, and because the window for giving it is so brief, a doctor who fails to so so when therapeutic hypothermia is called for may be committing medical malpractice.

Other treatments for the effects of HIE will depend on the specific types of disability a child is experiencing. Physical therapy, occupational therapy, sensory integration therapy, speech and language therapy, and behavioral and emotional therapy are common, as is the use of medications to treat seizures or blood pressure issues. Stem cell therapy has shown some promise for children diagnosed with HIE. While this type of treatment is difficult to access in the United States, it does offer hope for the future.

What to Do if Your Child is Diagnosed with HIE

If your child is diagnosed with HIE, you may rightly be wondering what the future holds and what to do next. Depending on your child’s needs, the cost of medical treatment, therapy, and perhaps lifelong care can be staggering. If you think your child’s condition was caused or worsened by treatment around his or her birth, your doctors or hospital might be responsible for some of that cost. We invite you to contact an experienced Oregon birth injury attorney to discuss your options.

Categories: Medical Malpractice