What Is Hypoxic-Ischemic Encephalopathy (HIE)?

Hypoxic-ischemic encephalopathy (HIE) is a type of newborn brain damage caused by oxygen deprivation and limited blood flow. HIE is a type of birth injury; ... SkiptoprimarynavigationSkiptomaincontentSkiptoprimarysidebarSkiptofooter CallForFreeCaseReview:888-329-0122 Home/WhatIsHypoxic-IschemicEncephalopathy(HIE)? Definition TypesandForms Prevalence/Incidence LifeExpectancy AssociatedConditions Long-TermOutcomes CausesandRiskFactors FiveMisperceptions Whatishypoxic-ischemicencephalopathy(HIE)? Hypoxic-ischemicencephalopathy(HIE)isatypeofnewbornbraindamagecausedbyoxygendeprivationandlimitedbloodflow.HIEisatypeofbirthinjury;thisisabroadtermusedtorefertoanyharmthatababyexperiencesatornearthetimeofbirth.OthertermsusedforHIEincludebirthasphyxia,perinatalasphyxia,andneonatalencephalopathy. Insomecases,therapeutichypothermiacanpreventorminimizepermanentbraindamage,althoughitmustbegivenwithinjusthoursofthebaby’sbirth/oxygen-deprivinginjury(see“TreatmentforHIE”formoreinformation).However,withandwithouttherapeutichypothermia,manyinfantswithHIEgoontodeveloppermanenthealthconditionsanddisorders.Theseincludecerebralpalsy(CP),cognitivedisabilities,epilepsy,hearingandvisionimpairments,andmuchmore. ThefullextentofdamagefromHIEistypicallynotapparentimmediatelyafterbirth,fortwomajorreasons: BraininjuryfromHIEisanevolvingprocess.Whenbloodflowiscutofftopartsofthebrain,cellsbegintobreakdown,die,andreleasesubstanceswhicharetoxictoothercells.Thesecellsthenbegintodieoffandcontinuethechainreaction,whichcausesbraininjurytospreadoveraperiodofhoursordays.Therapeutichypothermiacanhelptodisruptthischainreaction. DamagefromHIEmayoccasionallynotbecomeapparentuntilachildhasdevelopmentaldelays.Forexample,impactsonmobilitymaynotbenoticeduntilthechildstrugglestomeetmilestonessuchascrawlingorwalking. Oncethereispermanentbraindamage,thereisnocureforHIE.However,therearemanytreatmentsandtherapiesthatcanimprovesymptomsandfunctioninchildrenwithHIE. WhatarethecausesofHIE? HIEcanbecausedbyavarietyofmedicalcomplicationsaroundthetimeofbirth.Inmanycases,medicalmalpracticealsoplaysarole.Forexample,doctorsmayfailtoproperlymonitorthehealthofthemotherandbabyandidentifypotentialissues.Alternatively,theymayrecognizeproblemsbutnottakethemseriouslyenough/failtointervene.LearnmoreinformationontheassociationbetweenHIEandmalpractice,aswellaslegaloptions. Forover20years,ourlegalteamhasfoughtonbehalfofchildrenwithHIEasaresultofmedicalmalpractice. Getafreelegalconsultation ThefollowinghealthproblemsandnegligentactionscanleadtoHIE(thesearejustafewexamples;formoreinformationpleaseseethispage): Mismanagementofahigh-riskpregnancy:Womenwithconditionssuchaspreeclampsiaandgestationaldiabetesrequiremoreextensivemonitoringandtreatment. Umbilicalcordcomplications:Theumbilicalcordislikealifelinebetweenmotherandbaby,supplyingoxygenandnutrientsandremovingfetalwaste.AnythingthatcompressesthecordorreducesitsfunctionputsthebabyatriskofHIE. Placentaloruterinecomplications:Theplacentaanduterusalsoplayveryimportantrolesinprovidingoxygenatedbloodtothebaby.ExamplesofplacentalanduterineissuesthatmaycauseHIEinclude: Placentalabruption:whentheplacentaseparatesfromtheuterusbeforethebabyisborn Placentaprevia:whentheplacentaattachestooclosetothecervix;thiscancausedangerousbleedingandoxygendeprivationduringdelivery Placentalinsufficiency:whentheplacentaisunabletodeliverenoughbloodtothebaby Uterinerupture:whentheuterustears,partiallyorcompletely Infections:Infectionsinthemothercanspreadtothebabyduringlaboranddelivery,especiallyifthemedicalteamdonottakeadequateprecautions(suchasdoingindicatedinfectionscreeningandprescribingantibioticswhenneeded). Improperfetalheartmonitoring:Ifababyshowssignsoffetaldistressonthefetalheartmonitor,doctorsandnursescanoftenintervenesothattheiroxygensupplyisrestored.Ifnecessary,thismayinvolveanemergencyC-section.However,ifmonitoringissporadicordoesnotoccur,importantsignsofdangermaybemissed. Failuretopreventaprematurebirth:PrematurebabiesareathigherriskforHIEandotherbirthinjuriesbecausetheirlungsaresounderdeveloped.Therefore,itisveryimportantthatdoctorsdowhattheycantopreventprematurebirth,suchasperformingacervicalcerclage(astitchplacedinthecervixtostopitfromopeningtooearly)orprovidingprogesteronetreatment. Allowingprolongedlabortocontinue:Laborisstressfulforbabiesbecauseuterinecontractionscompresstheplacentaandumbilicalcordthatsupplytheiroxygen.Ifsomethingispreventinglaborfromprogressing,andphysiciansdonotofferintervention(suchasanemergencyC-section),thisisnegligence.Prolongedlaborismorelikelytooccurwhenababyislargerthannormal,orthemother’spelvisissmallerthannormal. Medicationproblems:SometimesphysiciansprescribemedicationssuchasPitocinandCytotecinordertoinduceorenhancelabor.Unfortunately,thesemedicationscanalsocauseuterinecontractionstobecomesostrongandfrequentthatthebabyisdangerouslydeprivedofoxygen. Mismanagementofaneonatalcondition:Hypoxic-ischemicinjurycanbecausedbycomplicationsduringtheneonatalperiod,i.e.ababy’sfirstmonthoflife.Problemssuchasrespiratorydistress,jaundice,andneonatalhypoglycemiacanallcontributetoanHIEdiagnosis,especiallyifmismanaged. WhatarethesignsandsymptomsofHIE? BabieswithHIEmayexhibitanyofthefollowingsigns(amongothers): Breathingproblems Feedingproblems Missingreflexes(forexample,thebabydoesnotrespondtoloudnoises) Seizures LowApgarscores Loworhighmuscletone Alteredlevelofconsciousness(e.g.notalert) Howdoyoupronouncehypoxic-ischemicencephalopathy(HIE)? TreatmentforHIE HIEismanagedusingatreatmentcalledtherapeutichypothermia,wherethebaby’sbrainorbodyiscooleddownbelownormaltemperaturestoslowthecascadeeffectthatcauseswidespreaddamage.Thisallowsthebaby’sbraintorecoverandreducesthelevelofdisabilitytheymayhaveastheygrow.Accordingtocurrentguidelines,thetreatmentmustbegivenwithinsixhoursofbirth,althoughthereissomeevidencetosuggestitmaybebeneficialwhengivenupto24hours. Therapeutichypothermialastsforaround72hours,allowingthebaby’smetabolicratetoslow.Thispreventsfurtherdamageknownasreperfusioninjury,whichoccurswhennormaloxygenationandbloodflowarerestoredtooquicklytothebrain’scells.Whileitmayseemcounter-intuitivethatrestoringflowquicklycouldcausefurtherinjury,thebrain’scellsreactdifferentlytorapidoxygenationafterbeingoxygendeprived.Afteroxygendeprivationinjury,rapidoxygenationcancausemoreinflammationandthereleaseofcertainharmfulcompounds.Hypothermiatreatmentworkstostabilizethebrain’scellsandpreventorlimitdamaginginflammation. Inadditiontotherapeutichypothermia,medicalstaffshouldprovidesupportivecare,whichcanmeanhelpingthebabybreathe,controllingandpreventingseizuresandlowbloodsugar,minimizingbrainswelling,andmore.Inthelongterm,babieswithbraindamagefromHIEmaybenefitfromawidevarietyoftreatmentsandtherapies.Althoughthesearenotcurative,theycanminimizesymptomsandmaximizefunction.Clickhereformoreinformation. TypesandformsofHIE IftheysuspectHIE,medicalstaffcanconductbrainimaging,suchasultrasoundandMRI,toseehowbadlytissueinthebrainisdamaged.CaregiversalsodoabloodgastesttodeterminethepHofthebaby’sblood,whichcanalsoprovidesomeinformationaboutthebaby’soxygenlevels. TheseverityofHIEisdeterminedusingSarnatstaging,whichtakesintoaccountclinicalpresentation,examresults,seizurepresence,andillnessduration. MildHIEisclassifiedasSarnatGradeI,andseverityincreasesuptoamaximalStageIII(1). PrevalenceandincidenceofHIE HIEisestimatedtooccurinbetween2to9per1,000livebirths.Theadventoftherapeutichypothermiahassignificantlyreducedratesofdeathanddisability,butoutcomescanstillbesevere.Inonestudy,nearlyhalfofnewbornswithHIEeitherdiedorhadamajorneurodevelopmentaldisabilityatan18-monthfollow-up.However,40percentofbabiesinthisstudyhadnormalearlydevelopment(2). LifeexpectancyforpeoplewithHIEandcerebralpalsy Thelifeexpectancyofpeoplewithhypoxic-ischemicencephalopathydependsgreatlyontheextenttowhichtheyareaffectedandtheiraccesstotreatmentsandtherapies.Forthisreason,it’sdifficultprovidean“average”lifespanforpeoplewithHIE.BecausemanychildrenwithHIEarealsodiagnosedwithcerebralpalsy,itmaybemoreusefultolookatlifeexpectanciesforpeoplewithcerebralpalsy. Peoplewithverymildcerebralpalsyaretypicallyexpectedtoliveaslongastheirpeersinthegeneralpopulation.Overall,lifeexpectancyforapersonwithcerebralpalsydependsontheextenttowhichtheyareaffected: Lifespanofmildcerebralpalsy:Forpeoplewithfairlymildcerebralpalsy(definedaswalkingunaided),lifeexpectancyinfemaleshasbeenestimatedat70-80years,andinmalesat66-76years. Lifespanofseverecerebralpalsy:Forthosewhoaremoreseverelyaffected(definedasaninabilitytolifttheheadandbeingfedthroughatube),lifeexpectancieshavebeenestimatedtobeshorterforbothfemalesandmales,dependingonthequalityofmedicalcarereceived. Theselifespannumberswereextractedfroma2008studyinDevelopmentalMedicineandChildNeurology.Clickheretoviewthepaper,whichcontainsadetailedtableonlifeexpectancyforpeoplewithcerebralpalsy.Ittakesintoaccountage,sex,movementability,andfeedingmechanism(3). MoredetailedinformationonHIE FormoreinformationonHIE,pleasevisitourMedicalInformationsection. AbouttheHIEHelpCenterandABCLawCenters TheHIEHelpCenterisrunbyABCLawCenters,amedicalmalpracticefirmexclusivelyhandlingcasesinvolvingHIEandotherbirthinjuries.Ourlawyershaveover100yearsofcombinedexperiencewiththistypeoflaw,andhavebeenadvocatingforchildrenwithHIEandrelateddisabilitiessincethefirm’sinceptionin1997. Wearepassionateabouthelpingfamiliesobtainthecompensationnecessarytocovertheirextensivemedicalbills,lossofwages(ifoneorbothparentshavetomissworkinordertocarefortheirchild),assistivetechnology,andothernecessities. Ifyoususpectyourchild’sHIEmayhavebeencausedbymedicalnegligence,pleasecontactustodaytolearnmoreaboutpursuingacase.Weprovidefreelegalconsultations,duringwhichwewillinformyouofyourlegaloptionsandansweranyquestionsyouhave.Moreover,youwouldpaynothingthroughouttheentirelegalprocessunlessweobtainafavorablesettlement. Youarealsowelcometoreachouttouswithinquiriesthatarenotrelatedtomalpractice.Wecannotprovideindividualizedmedicaladvice,butwe’rehappytotrackdowninformationalresourcesforyou. Citations Sarnat,H.B.,&Sarnat,M.S.(1976).Neonatalencephalopathyfollowingfetaldistress:aclinicalandelectroencephalographicstudy.Archivesofneurology,33(10),696-705. (n.d.).RetrievedJanuary15,2019,fromhttps://www.uptodate.com/contents/clinical-features-diagnosis-and-treatment-of-neonatal-encephalopathy Strauss,D.,Brooks,J.,Rosenbloom,L.,&Shavelle,R.(2008).Lifeexpectancyincerebralpalsy:anupdate.DevelopmentalMedicine&ChildNeurology,50(7),487-493. DownloadthispageasPDF Searchthiswebsite HAVEQUESTIONS?OURTEAMHASANSWERSHIEHelpCenteremploysateamofmedicalandlegalprofessionalstohelpanswerparent'squestions.Fillouttheformbeloworcall866-645-4072togetanswersandguidancetoday. About TheHIEHelpCenterservesasaninformationalresourceguideforfamiliesofchildrenwithhypoxic-ischemicencephalopathy(HIE).ItissponsoredbyABCLawCenters,abirthtraumalawfirmthathasrepresentedfamiliesofchildrenwithHIEandotherbirthinjuriesforover20years. Contact HIEHelpCenter 866-535-4809 ContactUs OwnedbyABCLawCenters&JesseReiter 122ConcordRd BloomfieldHills,MI48304 FollowUs FollowusonFacebook FollowusonTwitter Pinterest