Hypoxic Ischemic Encephalopathy (HIE)

Hypoxic Ischemic Encephalopathy

What is HIE?

HIE, hypoxic ischemic encephalopathy, is the inadequate distribution (but not complete deprivation) of oxygen to the entire brain. This condition can occur when an infant suffers birth asphyxia. HIE causes damage to the cells of the central nervous system (spinal cord and brain).

Causes

The primary causes of HIE are reduced cerebral blood flow (CBF) and/or systemic hypoxemia (low levels of oxygen in the blood). These causes can result from umbilical cord injuries, uterine and placental rupture, tachysystole (excessive uterine contractions), delayed delivery, complications due to the baby’s size or position, undiagnosed or untreated conditions in the mother (such as infection or preeclampsia), improper fetal heart rate monitoring, or trauma to the brain during delivery.

Diagnosis and Prognosis

Symptoms can range from mild to fatal, depending on the severity of the HIE:

Mild Symptoms. Mild symptoms, which are typically resolved with 24 hours of birth, include slightly increased muscle tone and brisk tendon reflexes, irritability, poor feeding, and excessive crying and sleepiness (typically alternating).

Moderate Symptoms. Moderate symptoms include lethargy, significantly decreased muscle tone (hypotonia), diminished deep tendon reflexes, sluggish reflexes (sucking, grasping, Moro), occasional periods of apnea, and seizures that typically begin within the first 24 hours following birth.

Severe Symptoms. Babies suffering from severe HIE typically display many of the moderate symptoms, but also suffer from delayed seizures that are initially resistant to conventional treatment. Increasing in frequency during the 24-48 hours after onset, these seizures are usually generalized and correlate with the phase of reperfusion (restoration of blood flow). Stupor and coma are common, and the infant becomes unresponsive to most stimuli.

With severe HIE, ocular motion is skewed, and pupils become dilated, fixed, or poorly reactive to light. Breathing may become irregular, often necessitating ventilator support. Irregularities in heart rate or blood pressure, as well as complete cardio respiratory failure, can also occur during the period of reperfusion. Severe HIE often results in severe brain injury or death.

Rapid Recognition and Treatment

As with most birth injuries, quick assessment and timely treatment can make a tremendous difference in the outcome for an infant suffering from HIE. It is important for the medical professionals treating you and your child to recognize risk factors and diagnose anything unusual in your infant’s behavior or physical responses.

Indications of HIE include:

  • low Apgar scores
  • seizures
  • hypotonia (floppy baby syndrome)
  • coma
  • abnormal limpness
  • difficulty feeding (inability to latch, suck, or swallow)

Confirmation and Treatment Options

Usually, HIE is suspected in a newborn who is exhibiting symptoms or has suffered a traumatic delivery. Occasionally, the condition is not evident until later, when the child fails to meet developmental milestones or exhibits impaired motor function. If HIE is suspected, it should be confirmed by tests and neuroimaging studies that may include MRI, PET scans, EEG, ultrasound, CT scans, hearing tests, retinal and ophthalmic examination, and arterial blood gas and blood glucose tests.

Once confirmed, HIE should be treated with largely supportive care, focusing on adequate ventilation, perfusion and blood pressure management, careful fluid and blood sugar management, treatment to reduce and eliminate seizures, and hypothermic treatment (brain cooling). Hypothermia cools the infant to 91 degrees Fahrenheit for 72 hours, slowing the metabolic processes and minimizing cell damage as blood flow is restored. This rather new therapy, called brain cooling, has been shown to successfully reduce the severity of neurologic injury for birth-associated HIE.

Getting Help for Your Baby’s Birth Injury

The birth of your child should be a joyous occasions. When something goes wrong, your innocent baby suffers. If you believe that the team of medical professionals (doctors, nurses, hospital staff) that you have entrusted with your child’s care has been negligent in any way, a birth injury is even more devastating.

Many parents have no idea where to turn in such situations. It’s important to know your rights and to determine whether or not you are entitled to monetary compensation for you and your child. A child suffering from any type of birth injury may need lifelong medical treatment and specialized care, which can be very expensive. Additionally, you may find that in caring for your child you are unable to return to a full-time work schedule, leaving the financial future of your family in jeopardy.

We can help you know your rights and receive compensation for your child’s birth injury. A free, no-obligation consultation with a member of the expert legal team at Thurswell Law (248-354-2222) is just a phone call away. And remember: you never pay anything unless we get money for you.Hypoxic Ischemic Encephalopathy

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