Birth and delivery put stress on a baby. To protect the baby and minimize the dangers of giving birth, medical professionals must use extreme care during labor, including monitoring fetal heart rate changes from baseline—a marker of fetal well-being—to ensure that the baby is getting enough oxygen and is non-acidotic. When a baby is deprived of oxygen for any number of reasons at or around the time of their birth, they may experience brain damage.

What Is Hypoxic Ischemic Encephalopathy?

Hypoxic ischemic encephalopathy, or HIE, is a type of brain damage in newborn babies. Oxygen deprivation and limited blood flow cause this kind of brain damage. HIE is a broad term used to describe the harm that a baby experiences from a birth injury at or around the time of their birth.

You may also hear HIE referred to as:

• Birth asphyxia
• Perinatal asphyxia
• Neonatal encephalopathy

A lack of oxygen supplied to a baby’s brain due to an interruption in or poor oxygen supply often happens for a brief period because of the stress of labor and delivery. Brief periods of interruption of blood flow, and therefore oxygen delivery, happen all the time and are not necessarily harmful unless they are repetitive and continue for a considerable period of time—30 minutes or so. If the oxygen is cut off repetitively for 30 minutes or more, the baby may develop partial asphyxia. If the blood supply and oxygen is cut off completely for 10 minutes or so, the baby will develop acute total asphyxia.

Hypoxic Ischemic Encephalopathy Causes and Risk Factors

Hypoxic ischemic encephalopathy destroys tissue in the brain’s cerebral motor cortex, as well as other parts of the brain. Some common causes of this type of brain damage include:

• Detachment of the placenta
• Rupture of the uterus
• Severe maternal low blood pressure
• Severe trauma to the baby’s head during labor and delivery
• Umbilical cord problems

The most significant risk factor for hypoxic ischemic encephalopathy is asphyxia. Asphyxia does not always lead to HIE—the severity and length of oxygen deprivation plays a role in whether or not HIE occurs and how severe it is if it does occur.

Some events that may lead to asphyxia in a baby include:

• Acute maternal hypotension, or low blood pressure
• Cardiac complications
• Cephalopelvic disproportion causing injury
• Intrapartum hemorrhage
• Placental abruption
• Poorly functioning lungs, leading to less oxygen in the blood
• Poor oxygen supply/interruption of breathing
• Prolapsed cord
• Trauma
• Umbilical cord complications causing injury
• Uterine rupture
• Vasa previa rupture

A fetal stroke may also increase the chance that HIE occurs. Some factors that can potentially cause a fetal stroke include:

• Abnormalities in blood clotting
• Blocked blood flow in the placenta
• Blood pressure that is too high or too low in the mother
• Pelvic inflammatory disease or other maternal infection
• Ruptured blood vessels due to weakness or malformation

When Will I Notice Damage from Hypoxic Ischemic Encephalopathy?

The full extent of brain damage from hypoxic ischemic encephalopathy typically is not clear right after a child’s birth. This is because:

• This type of brain injury progresses over time. Cells begin to break down and die, as well as release toxic substances to other cells, when blood flow is cut off. A chain reaction may occur in which the next cells begin to die. As a result, a brain injury in a baby has the potential to spread over hours or days.
• Damage may not be apparent before your child exhibits developmental delays. You may not notice impacts on mobility until your child struggles to reach crawling and walking milestones, for example.

Immediate brain cooling treatment may reduce brain damage in a baby. However, there is no cure for hypoxic ischemic encephalopathy once there is permanent brain damage.

Possible Health Effects Related to Hypoxic Ischemic Encephalopathy

Some children may not experience health issues from hypoxic ischemic encephalopathy. Others may only have mild or moderate effects. Still others may have a severe and permanent disability, including:

• Movement disorders
• Cognitive impairment
• Developmental delay
• Epilepsy

Additionally, when blood flow or oxygen supply to a baby’s brain is interrupted, the rest of their body may be deprived of oxygen as well. This oxygen deprivation has the potential to cause damage to other organs, such as:

• Bowels
• Heart
• Kidney
• Liver

Often, these organs have the potential to return to normal function. When the brain has sustained an injury, however, it may not recover fully.

Symptoms of Hypoxic Ischemic Encephalopathy

If your child has hypoxic ischemic encephalopathy, their symptoms may depend on the severity and the extent of their brain injury. Symptoms may also depend on the areas of the brain that were affected.

Babies with HIE may have symptoms such as:

• Being “floppy” and unreactive to stimulation such as sounds or sights
• Being very tense and overly reactive to stimulation such as sounds or sights
• Having abnormal movements
• Having seizures
• Having a weak cry
• Having feeding problems
• Showing signs of organ dysfunction, particularly involving the blood, heart, lungs, kidney and/or liver

Incredible advances in treatment have been made to help children who are living with cerebral palsy, but CP can still have a huge financial and emotional impact on a child and their family. If you believe your child’s cerebral palsy is a result of preventable hypoxic ischemic encephalopathy, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC .to learn about how we can help you determine if you have a case for compensation.

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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