Anoxia occurs when the body or brain loses its oxygen supply. In the context of childbirth, when oxygen deprivation takes place, it can contribute to a form of brain damage caused by oxygen loss known as hypoxic-ischemic encephalopathy (HIE). HIE can result in cognitive and motor deficiencies that may impair a child’s development and contribute to lifelong complications like cerebral palsy.

What Is Hypoxic-Ischemic Encephalopathy (HIE)?

HIE is a hypoxic-ischemic brain injury that occurs when an infant’s brain is deprived of oxygen and/or blood flow in the brain is decreased. Newborns who experience oxygen deprivation, or intrapartum asphyxia, can only endure depleted oxygen levels for a short time before brain tissue is affected. In severe cases, HIE due to neonatal asphyxia and fetal ischemic hypoxia can lead to death or result in severe cognitive and physical impairments such as epilepsy or neurodevelopmental delays.

Neuroimaging methods, such as MRIs, can be used to diagnose suspected cases of HIE. Doctors may suspect and test for HIE if a birth was traumatic, a birth injury occurred or if a significant condition, such as fetal stroke, took place. If a child does not receive a diagnosis at birth, doctors and parents should look for signs such as motor function impairment, developmental milestone delays, and delayed growth.

Certain indicators of HIE may occur after birth. Organ functioning abnormalities, particularly in the heart, kidneys, liver and lungs, can also point to possible HIE. Seizures in infants within the first 24 hours of life could also indicate hypoxic-ischemic encephalopathy.

How HIE Causes Brain Damage

If a newborn’s brain doesn’t receive adequate oxygen for some time, it injures the brain cells and can lead to permanent brain damage. The severity of the oxygen deprivation can affect the area of the brain sustaining the injury.

While full-term infants are susceptible to HIE, this brain injury can also occur in premature infants. If this injury takes place before the 35th week of fetal development, HIE could produce periventricular leukomalacia, a condition that results in the death of areas of brain tissue around ventricles, or fluid-filled sacs in the brain, causing holes or pockets to develop in brain tissue.

At 40 weeks of fetal development, the severity of hypoxia is reflected in the area of the brain sustaining the injury. Intermittent episodes of hypoxia generally result in parasagittal white matter injuries, while sudden and profound forms of hypoxia affect the thalamus and basal ganglia (the deep part of the brain).. The affected area of the brain can have a significant influence on symptoms the child may experience later in life.

Birthing Complications That Can Result in HIE and Infant Brain Damage

Birthing complications and other maternal and neonatal factors can put an infant at risk for hypoxic-ischemic brain damage.
Asphyxia is the most significant risk factor for HIE. How severe and how long oxygen deprivation takes place can affect whether HIE occurs and its severity. Certain events leading to asphyxia include:

• Cranial pressure resulting in changes in shape, bleeding, or decreased blood flow to the brain
• Injuries from umbilical cord complications
• Interruptions in blood flow to the baby
• Intrapartum hemorrhage
• Labor and delivery stress
• Uterine rupture
• Low maternal blood pressure

Fetal stroke also increases the possibility of hypoxic-ischemic encephalopathy occurring. A fetal stroke could result from:

• Abnormal blood clotting
• Constrained blood flow in the placenta
• Poorly developed blood vessels that may rupture
• High or low maternal blood pressure
• Maternal infection, such as pelvic inflammatory disease

Prevention

Preventing birth asphyxia and HIE involves:

• Close monitoring of the baby and mother to detect and respond to fetal distress
• Careful delivery of the baby once signs of fetal distress are detected

Doctors can take certain preventive measures during pregnancy and delivery, but new moms can also take an active role in learning about prevention methods for HIE, such as:

• Understanding how electronic fetal monitoring can provide critical information to the delivery team
• Confirming that the medical staff present during delivery have the necessary qualifications
• Verifying that a certified and properly trained obstetrician and anesthesiologist or Certified Registered Nurse Anesthetist will be present during delivery
• Reviewing your rights as a patient, such as the right to a second opinion and the right not to be pressured into making a quick decision when unnecessary

During pregnancy, both the mother and the baby should receive regular prenatal tests to monitor fetal health and wellness. If doctors believe that it may be a high-risk pregnancy, they may request more frequent prenatal testing with possible referral to a maternal-fetal specialist. When delivery is imminent, as soon as the mother enters the delivery unit, the delivery team should monitor the baby’s heart rate through fetal heart rate monitors.

Through awareness and careful monitoring, healthcare professionals can detect and respond to indicators of hypoxic-ischemic encephalopathy in infants.

If your child suffered from medical malpractice that led to HIE and cerebral palsy, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs today for a free, no-obligation consultation. Our cerebral palsy family lawyers are here to uncover the truth and seek the compensation you deserve.

Reviewed by:
Trish Fletcher, MS, BSN, CRNP, NNP-BC, ALNC
Neonatal Nurse Practitioner | Birth Injury Legal Nurse Consultant

Tricia is a dedicated, focused, Birth Injury Legal Nurse Consultant and Neonatal Nurse Practitioner with more than 25 years of experience. Her strong clinical and critical thinking skills, paired with expertise caring for neonates in a Level III Neonatal Intensive Care Unit (NICU), ensures meticulous medical records review. READ FULL BIO

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