If your baby was deprived of oxygen and blood in the womb, or during a complicated labor and delivery, he or she may have suffered from a birth injury like infant hypoxic-ischemic encephalopathy (HIE). HIE is a type of brain damage caused by oxygen and blood deprivation, and can be extremely dangerous.

Infant Hypoxic-Ischemic Encephalopathy (HIE): An Overview

Prevalence of Hypoxic-Ischemic Encephalopathy

HIE is one of the primary causes of infant deaths worldwide, and is a serious concern in the United States. According to MedScape, Asphyxia at birth, including HIE, accounts for 23 percent of all worldwide neonatal deaths, or roughly 840,000 deaths. It is also one of the leading causes of severe or permanent impairment in the U.S. HIE most commonly occurs during the perinatal period, which is during or shortly after delivery. It can affect full-term, and premature infants.

Causes of Hypoxic-Ischemic Encephalopathy

HIE as a form of asphyxia may be caused by a variety of conditions and circumstances, and can range in severity. Some of the most common conditions that lead to HIE include:

  • Umbilical cord complications or injuries
  • Lack of oxygen in the blood
  • Maternal hypotension
  • Maternal diabetes
  • Drug or alcohol abuse
  • Fetal anemia
  • Congenital infections or brain malformations
  • Uterine rupture
  • Preeclampsia/eclampsia
  • Cord prolapse
  • Stressful or prolonged labor and delivery
  • Medical negligence resulting in birth injury

What factors lead to HIE or contribute to its severity will depend on the overall health of you and your child, as well as when the HIE or asphyxia injury occurs.

Symptoms of Hypoxic-Ischemic Encephalopathy

HIE is most often broken down into three levels of severity – mild, moderate, and severe. A brief description of the symptoms that may be present within each stage includes:

Mild HIE – Symptoms generally resolve within 24 hours.

  • Slight increase in muscle tone and tendon reflexes
  • Poor feeding
  • Irritability
  • Excessive crying
  • Lethargy

Moderate HIE – When properly treated, symptoms generally resolve within 1-2 weeks.

  • Significant lethargy
  • Diminished tendon reflexes
  • Poor or absent sucking and grasping reflexes
  • Periods of apnea
  • Seizures (generally occurring in the first 24 hours post-delivery)

Severe HIE – Symptoms are severe and dangerous, and may result in long-term or permanent disability. Outcomes generally depend on the individual case.

  • Seizures in first 24-48 hours post-delivery with potential for increasing frequency
  • Edema (swelling) in the brain
  • Extreme lethargy, stupor, or coma
  • Irregular breathing (often requires ventilator support)
  • Absent sucking, grasping, and swallowing reflexes
  • Pupil dilation, fixation, or disturbed eye movements
  • Irregular heart rate, blood pressure, and reflexes

Treatment of Hypoxic-Ischemic Encephalopathy

Treatment of HIE most often depends on the health of the child, any associated or relevant medical conditions, and the situation in which the injury occurred. In general, treatment of HIE includes a series of processes and treatments designed to prevent further brain damage, restore functions, prevent permanent disability. Common treatment methods include:

  • Maintenance of blood glucose and blood pressure
  • Prevention or control of seizures
  • Ventilator support to help the child breathe without stress
  • Hyperbaric oxygen treatment (used in cases where carbon monoxide is the cause of HIE)
  • Cooling therapy to reduce brain swelling and slow the progress of damage

Treatment of HIE largely relies on healthcare providers recognizing the signs of a birth injury, assessing the situation, and administering proper treatment immediately. Outcomes in children with HIE are increasingly positive when symptoms and related conditions are diagnosed and treated as soon as possible.


The mortality rate for children with HIE depends on the severity of the condition, treatment administered, and level of permanent damage. MedScape reports the following data about HIE morbidity and mortality:

  • The mortality rate for severe HIE is 25-50 percent
  • Almost 80 percent of infants diagnosed with HIE develop additional serious complications
  • Infants with moderately severe HIE have a 30-50 percent chance of developing long-term complications
  • 10-20 percent of infants with HIE develop moderate to severe disabilities
  • 15-20 percent of children with a history of HIE studied revealed learning disabilities.

What Parents can Do

If your child was diagnosed with HIE during delivery or shortly thereafter, there is no doubt that you have many questions and concerns about your family’s future. Any birth injury can have a serious effect on you and your loved ones, and can present unique challenges as your little one changes and matures. Here are some helpful tips for dealing with a birth injury:

  • Be Honest – Any time you have questions or concerns about your child’s health, be honest with your pediatrician or relevant healthcare providers. Your child’s health may require a team of professionals, and it is important that you can trust them to support and guide you.
  • Keep Records – It is always advisable to keep records of your child’s condition, including any events that occurred during labor and delivery, diagnosis and treatment records, and even financial statements. In the event that your child’s birth injury was caused by medical negligence, these records will make a tremendous difference in your ability to file a legal claim.
  • Life Care PlansLife Care Plans are an excellent tool for parents managing a birth injury. A Life Care Plan is designed to help parents and caregivers understand the diagnosis, treatment, short- and long-term goals and needs, and requirements for raising a child who was injured at birth. Life Care Plans may include estimated costs for care, educational planning, required treatment or therapies, and a list of applicable professionals and their role in the child’s life.
  • Talk to an Attorney – If you are concerned that your child’s birth injury was caused by medical negligence, you should contact a medical malpractice and birth injury attorney to learn more about your legal rights, and what options you may have. An attorney can help you understand the responsibilities of healthcare providers and determine if your rights have been violated.
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