What Causes Hypoxic Ischemic Brain Injury?

Birth Injury

illustration of orange human brain being assaulted by yellow arrows arranged around it on a blue background

Hypoxic ischemic encephalopathy (HIE) is a serious and life-threatening type of brain damage that can occur in infants. Parents of children with a hypoxic ischemic brain injury at birth face emotional, physical, and financial stress. To better understand HIE, let’s go over the details of the condition, how it impacts families, and what to do if you believe your child’s HIE was caused by malpractice or negligence.

What is Hypoxic Ischemic Brain Injury?

HIE is a condition that occurs when oxygen and blood supply to a baby’s brain is limited during childbirth, causing brain cells to die within minutes. It is relatively rare but can be life-threatening and cause short- and long-term physical and neurological impairments. Hypoxic ischemic encephalopathy in adults is possible, but it is primarily seen in infants.

What are the Different Causes of HIE?

HIE is the result of a lack of blood flow to a baby’s brain and as a result, lack of oxygen, during pregnancy or childbirth. The lack of oxygen causes the brain to rapidly decay, resulting in the symptoms of HIE listed below. Parents of children with HIE may be wondering what causes the lack of blood and oxygen flow. There are several potential complications that can cause HIE, including those that occur during pregnancy and those that occur during labor and delivery. The causes can include:

Complications During Labor and Delivery

  • Placental abruption. This is when the placenta detaches, separating from the uterus prematurely before birth. Typically occurs around 25 weeks and in only 1-6% of all pregnancies.
  • Extremely low maternal blood pressure. Low blood pressure of the mother can affect the baby’s blood flow.
  • Umbilical cord prolapse. When the umbilical cord is pushed out of the cervix and vagina before the baby, causing the cord to compress and cutting off the baby’s blood supply. Very rare, occurring in only 0.14 to 0.62% of births.
  • Uterine rupture. This is when the uterus walls tear open. This is very rare, occurring in less than 1% of births.

Complications During Pregnancy

  • Maternal Infections. Although not all maternal infections are dangerous, some, such as strep b, rubella, chickenpox, syphilis, toxoplasmosis, hep b, and listeriosis can cause severe damage if not properly diagnosed and treated.
  • Placenta Blood Circulation Issues. Also called placental insufficiency, this condition is a serious abnormality in which the placenta fails to properly form or is damaged. This causes a lack of nutrients and oxygen for the baby.
  • Preeclampsia. This is a condition that causes the blood vessels to constrict, resulting in high blood pressure and reduced blood flow.
  • Stroke. Children are at risk for stroke before, during, or after birth. Because strokes are sometimes hard to identify in babies, they can go undiagnosed and cause issues such as HIE and cerebral palsy.
  • Cord Accidents: Cord might be wrapped around the neck and or body.
  • True Knot: This occurs when a knot randomly forms in the umbilical cord.
  • Umbilical Cord Prolapse: This occurs if the umbilical cord delivers before the baby causing compression of the cord.
  • Fetal-Maternal Hemorrhage: Can be caused by placental abruption and can occur when both mom and baby lose a significant amount of blood from internal bleeding.
  • Uterine Rupture: Uterine rupture can happen spontaneously or due to trauma. Attempting a vaginal birth after cesarean places mom and baby at risk for uterine rupture because there could be thinning of the uterus from prior c-section scar.

Complications Post-Birth

  • HIE from Blood Clotting Disorder: Blood clotting disorders such as MTHFR predisposes the infant to HIE.
  • Delayed Transition to Extrauterine Life or Inadequate Resuscitation
  • Hypoglycemia or Hyperglycemia
  • Meconium Aspiration Syndrome: When the infant has their first bowel movement in utero, they may aspirate the thick sticky meconium into their lungs. The inability to oxygenate the baby effectively can lead to HIE.
  • Infections: Chorioamnionitis or other bacterial infections that are undiagnosed can cause a baby to become septic- placing them at risk for HIE.

What are the Effects of HIE and How Serious are They?

HIE is a serious brain injury. It is quite rare but still manages to be one of the most common causes of infant death in the United States annually. Not only is HIE life-threatening, but 25% of survivors will suffer permanent brain damage of varying severity, resulting in physical disabilities and cognitive impairment. There are children who recover from HIE and experience little to no neurological symptoms. Every case is different.

What are the Symptoms of HIE?

Hypoxic ischemic brain injury symptoms in the moments after birth vary greatly depending on how severe the brain damage is. For example, mild HIE may result in abnormal reflexes, stiff muscles, irritability, issues with feeding, excessive crying, and an abnormal amount of sleep. Moderate HIE can result in lack of muscle tone, poor grasp and sucking reflex, apnea, and seizures within the first day after birth. Severe HIE usually results in extreme seizures, unresponsiveness, irregular breathing, hypotonia, abnormal eye control and heart rate, and cardiorespiratory failure that is often fatal. Hypoxic brain damage MRIs tend to show restricted diffusion in the cerebellar hemispheres, basal ganglia, or cerebral cortex. Hypoxic brain damage CTs show diffuse edema, decreased cortical gray matter attenuation, and decreased bilateral basal ganglia attenuation.

What Are Your Options if Your Child Has HIE?

If your child experienced hypoxic ischemic brain injury at birth, there are a variety of treatment methods and supportive care techniques that are available. One of the treatments for HIE that has gained popularity recently is therapeutic hypothermia, also known as body and head cooling. During this process, the baby’s temperature is brought below normal as soon as possible after birth. This is known to slow down cell damage and decay that occurs within the brain, minimizing the long-term effects of HIE. To help prevent additional injury from things such as seizure activity, poor perfusion, electrolyte imbalance, and abnormal glycemic control, additional supportive care is available.

Unfortunately, the damage that is caused by HIE is permanent. This means that children with HIE will need ongoing therapy, medication, life-long support, and special accommodations. What your child will need throughout their life is difficult to say, as most HIE effects are not fully known until the child is older. Although it is little consolation to families, there are children with HIE who have great success stories.

Did Medical Malpractice Cause Your Child’s Hypoxic Ischemic Brain Injury?

If your child is diagnosed with HIE and you believe it was caused by a form of medical malpractice, such as the mistreatment of infection or negligence during labor and delivery, you might be unsure what your next steps should be. HIE treatment and support can be costly and the emotional stress of your child experiencing such an injury can be detrimental to your family’s quality of life. If you believe your child’s HIE was caused by medical malpractice, seek the advice of an experienced medical malpractice law firm.

The Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC have consulted with over 30,000 families nationwide. We call upon our legal and medical experience to uncover the truth and seek the compensation families deserve. If your child suffered from medical malpractice that led to HIE, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs today for a free, no-obligation consultation.



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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