Hypoxic Ischemic Encephalopathy

What is Hypoxic Ischemic Encephalopathy?

Hypoxic ischemic encephalopathy (HIE) is a serious birth complication affecting full-term infants. It causes brain injury that can lead to a lifetime of disability or in some instances early demise. Decreased cerebral blood flow and oxygen delivery to the brain cause injury and death to neurons within the brain. Injury to the brain from oxygen deprivation is permanent.

What are Common Causes of Hypoxic Ischemic Encephalopathy?

HIE results from inadequate blood flow to the infant’s brain, which causes oxygen deprivation. This in turn injures the neurons and causes brain cell death. There are several conditions that can cause HIE. Some common causes are noted below.

1 – The baby can suffer a lack of oxygen during the pregnancy or labor due to problems that prevent the placenta from delivering a normal amount of blood to the fetus. This delivery of blood through body tissue (including through the placenta) is called perfusion. The placenta is the organ responsible for transferring blood and oxygen as well as nutrients to the fetus. Therefore, a problem with this critical placental perfusion activity is very serious.

• A rise in blood pressure during the pregnancy is often an early sign of a placental perfusion problem during pregnancy.
• Decreased placental blood flow prior to labor causes the baby to grow smaller than normal, something called intra-uterine growth restriction (IUGR). IUGR babies are less able to withstand the stress of labor and more susceptible to developing HIE during delivery than normal size babies.
• During labor and delivery, the fetal heart rate is monitored to watch for signs of decreased blood flow to the baby so that earlier delivery can be performed if the baby’s heart rate shows signs of decrease oxygenation.

2 – Other causes of intrapartum (during delivery) hypoxia can occur from an umbilical cord around the neck and partial separation of the placenta.

3 – HIE can also occur after birth if the baby is unable to breathe and move oxygen into his or her lungs for any reason. One cause of this is meconium aspiration syndrome (MAS). Meconium is the first bowel movement a baby makes, typically after birth. MAS happens if a baby expels large amounts of meconium prior to birth in utero from the stress of decreased oxygen, and breathes the meconium into its lungs. When the baby is born, the baby can’t draw air down into its lungs because the meconium blocks the airways. The baby then suffers a lack of oxygen leading to HIE.

What are the Symptoms of HIE?

Neonatal hypoxic ischemic encephalopathy can be mild to severe. The condition affects cognitive abilities, movement, and sensation in the child. In neonates, early symptoms of HIE include:

• Reduced level of consciousness
• Seizures (which peak at 48 hours)
• Difficulty initiating and maintaining respiration
• Depression of tone and reflexes

As the baby grows, other symptoms of HIE are signs of cerebral palsy; these include spasticity of limbs and difficulty walking and using arms can develop. Developmental delay and cognitive deficits can develop separately or in conjunction with these motor disorders. Blindness and the loss of other senses are other symptoms that can occur in severe cases.

MRI brain examinations can show the areas of brain damage. The manifestations of the brain damage depend on whether the lack of oxygen was a severe anoxia (complete lack of oxygen), a prolonged hypoxia (partial lack of oxygen), or both.

Are there Lasting Effects or Complications with Hypoxic Ischemic Encephalopathy?

Unfortunately, the injuries from hypoxic ischemic encephalopathy are permanent. Brain cells do not regenerate. When hypoxic ischemic encephalopathy is suspected at birth, the baby can undergo body cooling, which lessens the progression of the birth injury and the resultant disabilities. Other than that, neonatologists try to keep the baby well-oxygenated, monitor blood glucose levels, and provide supportive care while the injured brain heals.

There are lasting effects of hypoxic ischemic encephalopathy; their severity depends on a few factors: how long the oxygen deprivation lasted, the severity of that oxygen deprivation, and the baby’s condition at the time. Typical complications of hypoxic ischemic encephalopathy include:

• Severe hearing impairments or vision impairments
• Developmental delays and problems learning, thinking, and speaking
• Low mental development index (MDI) score
• Cerebral palsy
• Motor developmental problems, such as problems with coordination or walking
• Low psychomotor development index (PDI) score
• Seizure disorders or epilepsy

Contacting an Experienced Birth Injury Attorney

An experienced birth injury attorney like Britcher, Leone & Sergio, LLC can help parents find out whether their child’s birth injury was a result of an HIE event during pregnancy, labor, delivery, or in the postnatal period. There are specific things an experienced birth injury attorney knows to look for in the prenatal, labor and delivery records as well as NICU records. Knowing the factors of neonatal hypoxic ischemic encephalopathy makes a difference in sorting out the babies with HIE whose birth injury was caused by medical negligence from those whose conditions were not.