Hypoxic Ischemic Encephalopathy (HIE) is a type of birth injury that occurs when a newborn’s brain is deprived of oxygen due to decreased blood flow to the brain. The long-term effects of HIE depend on a number of factors, including the severity and duration of the oxygen deprivation. HIE is considered a type of brain injury.
There are numerous signs and symptoms of HIE, from decreased alertness immediately after birth, seizures or signs of organ failure in the first days of life to developmental delays in the first few years of life. When it is detected shortly after labour and delivery, HIE can be treated with therapeutic hypothermia (cooling therapy), which has been proven to reduce the risk of serious or permanent injury in more serious cases of HIE. Cooling therapy must generally be administered within the first 6 hours after birth to be effective.
At BILA, we are committed to supporting parents whose children have been diagnosed with HIE. In addition to offering legal services from our association of experienced HIE lawyers, we also offer information on HIE – including the signs and symptoms that parents should be aware of if they suspect that their child may have been oxygen deprived during labour and delivery.
Immediate Signs of HIE
Hypoxic ischemic encephalopathy (HIE) is a type of brain injury that occurs when the brain experiences a lack of oxygen or decreased blood flow. It may occur before birth, during labour and delivery, or after birth. The length of time that the brain spends without sufficient oxygen or blood flow can affect the severity of the brain damage.
Immediately after birth, the signs of HIE may include:
- Decreased alertness and activity (lethargy)
- Hyper alertness
- Lack of typical reflexes
- Difficulty feeding
- Breathing problems
- Abnormal movements or seizures
- Low muscle tone (hypotonia)
- Acidemia (low pH in umbilical cord blood gas tests)
- Abnormal response to light
If a doctor suspects that your baby has HIE, they will conduct multiple physical exams to track brain function. One of the primary exams used to determine whether a baby has HIE or another type of birth injury is the Apgar score. This standardized assessment consists of 5 components:
- Heart rate
- Muscle tone
Each category is given a score of 0, 1, or 2. The score is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals for infants with a score less than 7.
While a low Apgar score cannot diagnose asphyxia, it is a key indicator that an infant may have suffered oxygen deprivation. The lower the Apgar score, the more alert the medical team must be to monitor the infant and intervene if necessary. Other tests can be utilized to confirm a diagnosis of hypoxic-ischemic encephalopathy or another birth injury. Learn more about the importance of Apgar scores:
- APGAR test criteria
- How is the APGAR test scored?
- Low APGAR score meaning
- Low APGAR score causes
- What parents need to know about APGAR test results
Understanding the signs of HIE is critical to early diagnosis and prompt treatment with cooling therapy, which can reduce the likelihood of long-term effects in moderate to severe cases. It is also important to be aware of the potential causes of HIE. If these risk factors are present, then your baby should be closely monitored for signs of perinatal asphyxia.
Potential causes of HIE include:
- Umbilical cord wrapping around neck of the infant during labour and delivery (nuchal cord)
- True knots
- Umbilical cord prolapse
- Excessive uterine contractions, high material blood pressure, or complications during delivery that cause excessive umbilical cord compression
- Placental abruption
- Placenta previa
- Uterine rupture during delivery
- Brain trauma during delivery, which may be caused by the use of a vacuum, forceps, or another application of excessive force on the baby’s head
During any delivery, the infant should be closely monitored for warning signs of fetal distress and potential oxygen deprivation, such as elevated fetal heart rates or a falling heart rate. Prompt intervention may help avoid excessive oxygen deprivation and damage to the baby’s brain cells.
Signs and Symptoms of HIE During Infancy and Early Childhood
In some situations, HIE is not immediately apparent after birth. This often occurs in mild to moderate cases of HIE. Parents may not realize that their child may have suffered a birth injury until the child fails to meet developmental milestones or shows signs of a developmental delay.
Signs and symptoms of HIE in the months and years after a baby is born may include:
- Impaired motor function
- Seizure disorder (epilepsy)
- Delayed growth
- Hearing and visual impairments
- Delayed developmental milestones, such as holding their heads up, responding to sounds, rolling over, crawling, walking, and/or talking
If parents notice any of these signs and symptoms in their child, they should contact a medical professional. While cooling therapy is no longer one of the treatment options available at this point, there are many interventions and therapies that can maximize a child’s abilities.
Even if a baby does not show signs of a hypoxic-ischemic brain injury immediately after birth, if the infant suffered an oxygen deprivation event before, during, or after birth, medical professionals should still conduct tests to determine if there was any brain damage. A magnetic resonance imaging (MRI) of the brain or an electroencephalogram (EEG) can be used to detect neonatal hypoxic-ischemic encephalopathy in babies who do not show signs of HIE during the newborn period.
The long-term effects of HIE can vary significantly based on several factors, including the severity and duration of the oxygen deprivation, treatment immediately after the oxygen deprivation event, and the care that the child receives during the first few years. Doctors may use Sarnat staging to determine the severity of neonatal encephalopathy. Stage I is considered mild HIE, while Stage II is moderate and Stage III is severe.
Depending on which areas of the brain were affected and the severity of the damage to the brain, long-term effects of HIE may include:
- Cerebral palsy
- Epilepsy or seizure disorders
- Behavioural and emotional disorders
- Intellectual and/or developmental disabilities
- Learning disabilities
- Hearing and vision impairments
- Speech delays and language disorders
- Mental health issues
- Sensory processing disorders
- Orthopaedic conditions
While many of these conditions are not curable, various treatments and therapies can improve both symptoms and the quality of life for the affected child. As with many other types of birth injuries, early intervention is often key to ensure the best possible outcome.
Contact BILA for More Information
Dealing with HIE can be incredibly challenging for parents and families. If your baby has suffered birth asphyxia, it is important to seek support from people who understand what you are going through. We can help you connect with experts and other families to guide you through the coming days and months.
If your baby has been diagnosed with HIE or a related condition, the case should be considered by an experienced birth injury lawyer. Contact BILA today at 1-800-300-BILA or via our online contact form for more information about a potential legal claim and to discuss your child’s birth injury case,
Is HIE Always Caused by Medical Negligence?
Birth asphyxia is not always the result of medical negligence. However, hypoxic-ischemic encephalopathy often results from a failure to appropriately monitor, intervene, and/or treat an infant during pregnancy, labour and delivery, and after birth. A health care provider who fails to meet the standard of care may be held financially liable for any injuries that result.
If you suspect that your baby’s HIE was caused by medical negligence, the best course of action is to consult with a birth injury lawyer. They can review your case and advise you on the potential for filing a claim against the at-fault medical professionals and/or hospital.
Is It Possible for a Baby with Moderate HIE to Recover Fully?
If your baby has moderate to severe HIE, there is a risk of long-term effects or even neonatal death. To reduce this risk, babies with moderate to severe HIE will receive therapeutic hypothermia shortly after birth. Research shows that this type of cooling therapy can significantly reduce the risk of long-term disability when administered within 6 hours of birth.
A successful outcome for a baby with moderate HIE often depends on early intervention with cooling therapy to allow the brain to recover from a hypoxic-ischemic injury. The sooner this therapy begins, the greater the likelihood that the baby’s potential disabilities will be minimized.
How Serious Is HIE?
HIE has the potential to be incredibly serious, and may even lead to death in more severe cases. Babies with milder cases of HIE may suffer no or very mild long-term effects. Infants who suffered more prolonged oxygen deprivation may be diagnosed with a range of related conditions that can compromise their health, well-being, and independence.
HIE can often be prevented through careful monitoring and prompt intervention. If a medical professional fails to notice warning signs of HIE – such as fetal distress – or to intervene to reduce the likelihood of birth asphyxia, it may be considered medical negligence. Contact BILA to talk to a birth injury lawyer about your case.
Related: Causes of HIE