What Is Hypoxic Ischemic Encephalopathy (HIE)?

Understanding HIE, How it Happens, and Your Rights After an Infant Brain Injury

Hypoxic Ischemic Encephalopathy (HIE) is a serious brain injury that can occur in newborn babies during labor and delivery. It is caused by an interruption to the brain’s supply of oxygen and blood.

HIE is a medical emergency, and doctors must be prepared to perform life-saving intervention at a moment’s notice. HIE can cause lifelong disabilities for the newborn, including cerebral palsy. Some cases are fatal. 

Hypoxic ischemic encephalopathy is considered a birth injury. Many cases are preventable through diligent medical care. Doctors, hospitals, and other health care providers may be liable for failure to prevent, diagnose, or treat HIE during pregnancy, labor, and delivery.

What Is Hypoxic Ischemic Encephalopathy (HIE)? How Does It Affect the Brain?

Hypoxic ischemic encephalopathy develops in one of two ways:

• The brains loses its blood supply.

• There is adequate blood flow to the brain but not enough oxygen in the blood.

HIE typically happens during the perinatal period (just before, during, or just after delivery). Even a momentary interruption in the brain’s blood supply can cause injury to otherwise healthy cells, which begin to die off rapidly.

Even once oxygen-rich blood supply is restored, the baby’s brain may still be susceptible to further injury. As healthy blood enters damaged cells, they release dangerous toxins, a phenomenon known as ischemia-reperfusion injury (IRI) or reoxygenation injury.

The underlying causes of HIE can also lead to damage in other organs if they do not get enough oxygen-rich blood.  

HIE is the leading cause of infant fatality in the United States, as well as the leading cause of serious disability in newborns. It occurs in approximately 2% of all live births in the U.S., and in 60% of premature births. 

HIE Symptoms

Symptoms of hypoxic-ischemic encephalopathy in newborns include:

• Slow pulse (or, alternatively, no detectable heart rate)

• Acidosis (a buildup of acid in the blood)

• Slow or irregular breathing (or, alternatively, no detectable respiration)

• Meconium stain (infant fecal stain) in the mother’s amniotic fluid

• Poor muscle tone (a “floppy” or weak appearance)

• Blue or pale skin color

• Absent or depressed reflexes

• Seizures

• Reduced consciousness

• Feeding problems

• A low Apgar score (less than three, lasting longer than five minutes)

HIE Causes

The causes of hypoxic ischemic encephalopathy (HIE) depend on the stage of childbirth at which it develops.

Causes that develop at the very end of pregnancy but before delivery (antepartum causes of HIE) include:

• Preeclampsia / eclampsia

• Alcohol or drug abuse

• Gestational diabetes

• Infections

• Fetal deformities affecting vital organs

• Fetal macrosomia 

• Maternal blood clotting disorders

• Maternal vascular disease

• Cardiac problems, poor circulation to the placenta, or anything else that might keep the baby from receiving oxygenated blood while still in the womb

Causes that develop during delivery (intrapartum causes of HIE) include:

        • Placental abruption

• Placental blood clots

• Placental insufficiency

• Low maternal blood pressure

• Uterine rupture

• Umbilical cord compression

• Prolapsed umbilical cord

• Prolonged labor or other difficulties with delivery (e.g. abnormal positioning of fetus, shoulder dystocia, etc.)

Causes that develop soon after delivery (postpartum causes of HIE) include:

• Fetal heart disease

• Fetal pulmonary disease

• Low blood pressure in the newborn

• Trauma during delivery

• Dropped baby / other physical trauma

• Meningitis

• Any close call with SIDS

These are only some of the most common causes of hypoxic-ischemic encephalopathy. There are others. Every situation is different.

It is critical that doctors have an in-depth understanding of HIE beginning early in pregnancy so that they monitor the mother and baby and treat any emerging problems, such as preeclampsia or gestational diabetes, as soon as possible. With careful medical treatment, many cases of hypoxic-ischemic encephalopathy can be prevented.

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If your child has suffered injury or death as a result of hypoxic-ischemic encephalopathy, we encourage you to call our office and talk about your options.

The Miami birth injury attorneys at Kaire & Heffernan, LLC have extensive experience in helping families hold negligent health care providers accountable across the state of Florida.

We will not charge you for our services unless and until we recover compensation in your case, and the initial no-obligation consultation is absolutely free.

Schedule a free consultation with the Miami birth injury attorneys at Kaire & Heffernan, LLC today.