Lack of Oxygen During Birth | HIE

Brain InjuriesPerinatal hypoxic ischemic encephalopathy (HIE) is one of the most serious and life threatening types of infant brain damage that can occur during childbirth. HIE occurs when both oxygen and blood supply to a baby's brain is restricted or interrupted during childbirth (perinatal asphyxia) which causes brain cells to die after short periods.

What is Hypoxic Ischemic Encephalopathy (HIE)?

Encephalopathy is a medical word that is used to reference a various related conditions resulting from injury to the brain. Hypoxic ischemic encephalopathy (HIE) is specific type of brain injury triggered by a combination of: (1) hypoxia -- an interruption of oxygen circulation; and (2) ischemia - - blood flow restriction. Perinatal HIE occurs when blood and oxygen to the brain are simultaneously reduced or cutoff during childbirth or immediately after. HIE is a relatively rare event, occurring in about 3 out of every 1,000 births.

Effects of HIE

HIE is an extremely serious type of brain injury. Even though it only occurs in less than .05% of all births, HIE is one of the leading causes of infant mortality in the U.S. every year. Aside from being life-threatening, HIE also causes permanent brain damage. Somewhere between 15-20% newborns diagnosed with HIE will die in the first week. From the remainder that survive, 25% will suffer permanent brain damage to various degrees of severity. Brain injuries from HIE often result in physical disabilities and cognitive impairment. A smaller percentage of babies with HIE fully recover and experience only mild symptoms of neurologic injury.

Symptoms of HIE

HIE symptoms immediately after birth will vary significantly based primarily on the severity of the underlying brain damage:

Mild HIE
  • Tendon reflexes are abnormal and muscles stiff in first few days
  • Extreme irritability, feeding problems and excessive crying or sleeping
  • Symptoms of mild HIE often resolve within a few weeks
Moderate HIE
  • Lack of muscle tone (floppy baby syndrome) with absence of reflexes
  • Cannot grasp and has poor sucking reflex
  • Sporadic apnea
  • Seizures (typically within first day)
Severe HIE
  • Extreme seizures which increase in frequency in first 2 days
  • Not responsive to external stimulus
  • Irregular breathing
  • Extreme hypotonia (like rag doll)
  • Abnormal eye control or movement with dilated pupils
  • Abnormal heart rate and blood pressure
  • Cardiorespiratory failure (often fatal)
Causes of HIE?

HIE is the result of an interruption or severe restriction of oxygen and blood supply to the baby during childbirth. The disruption of the blood and oxygen circulation can be triggered by numerous events or complications arising during labor and delivery (or pregnancy).

Neonatal Causes of HIE
  • Maternal infections
  • Placenta blood circulation issues
  • Preeclampsia
Causes of HIE During Labor & Delivery
  • Placental abruption / bleeding
  • Excessively low maternal blood pressure
  • Umbilical cord complications
  • Uterine rupture
Treatment for HIE

Unfortunately, damage to the brain is basically permanent and cannot simply be fixed with surgery or medications like other areas of the body. HIE is therefore a permanent injury. Treatment options involve therapy and medication to help manage the effects of any brain damage. Babies with severe HIE injuries will often need life-long support and accommodations.