What HIE is
Hypoxic-ischemic encephalopathy is an umbrella term for a brain injury that happens before, during or shortly after birth when the supply of oxygen or blood flow to the baby’s brain is reduced or stopped. “Hypoxic” refers to reduced oxygen, “ischemic” to reduced blood flow, and “encephalopathy” to a disturbance of brain function. You may also hear the terms perinatal asphyxia, birth asphyxia or neonatal encephalopathy used for the same or overlapping situations.
How much HIE affects a child varies widely. Some children recover with few or no lasting effects; others have lasting difficulties with movement, learning, vision, hearing or seizures. The full picture can take months or years to become clear, and some effects are only apparent once a child reaches school age.
HIE and “neonatal encephalopathy”
Clinicians may use the broader term neonatal encephalopathy when a newborn shows disturbed brain function (for example reduced alertness, difficulty breathing or feeding, abnormal muscle tone or seizures) but the cause has not been established. The joint report of the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) on neonatal encephalopathy recommends this broader term when a full evaluation of the cause has not been possible, because encephalopathy in a newborn can have causes other than a lack of oxygen during labor.
What is known about causes
Reduced oxygen or blood flow to the brain can arise from events during pregnancy, during labor and delivery, or after birth. The ACOG and AAP report is explicit that every case of neonatal encephalopathy should be evaluated broadly, looking at the mother’s medical history, the course of the pregnancy, events during labor and delivery, and the placenta, among other factors, before concluding what contributed. In other words, the clinical guidance itself warns against assuming that an event in labor was the cause.
What a diagnosis does not tell you
A diagnosis of HIE describes what happened to the brain. It does not establish why it happened or whether it could have been prevented. Whether the care your family received met the accepted standard, and whether any shortfall caused the injury, are questions that can only be answered by a qualified review of the full medical record. No website, including this one, can answer them for your child.
How HIE is recognised and treated
In the hours after birth, the care team looks at how the baby is breathing, feeding, moving and responding, along with blood tests and, where indicated, brain imaging and monitoring for seizures. In some cases of HIE, a treatment called therapeutic hypothermia, or cooling, carefully lowers the baby’s body temperature for a period after birth. Whether cooling is offered, and when, depends on clinical criteria and the baby’s condition; the specific timing windows and eligibility rules used in your hospital are questions for your child’s care team.
Longer term, care often involves developmental follow-up and, depending on the child, physical, occupational or speech therapy, treatment for seizures, and support at school.
Monitoring during labor
During labor the baby’s heart rate is usually monitored, either continuously with electronic fetal monitoring or at intervals with a handheld device. Heart rate patterns are one piece of information the care team interprets in context. Families sometimes ask whether a pattern on the monitor “should have” led to an earlier delivery. That is a reasonable question, and it is exactly the kind of question that qualified reviewers examine using the full strip and the full record, not something a family can or should try to judge from memory.
What is uncertain
- How a particular child will develop. Early severity does not always predict the long-term outcome.
- In many cases, the precise timing of the injury, which is one reason ACOG and AAP call for a broad evaluation.
- Whether any specific intervention would have changed the outcome, which requires expert analysis of the individual case.
What a legal review would look at
If a family chooses to ask an attorney to review what happened, the attorney and the medical experts they engage will typically look at the prenatal records, the labor and delivery record including the monitoring strip, the timing of decisions, the resuscitation and newborn records, the placenta pathology if it was examined, and the baby’s subsequent course. The review asks two separate questions: did the care fall below the standard of care, and if so did that shortfall cause the injury. Both have to be answered, and in most birth injury matters both require physician experts. Time limits for bringing a claim differ by state and can be affected by the fact that the injured person is a child; because of that we do not state deadlines on this site until a state’s rules have been reviewed by an attorney licensed there.
Questions worth asking your child’s care team
- What is the diagnosis exactly, and what is the difference between “HIE” and “neonatal encephalopathy” in our child’s case?
- What evaluation has been done to understand what contributed?
- Was cooling therapy considered, and what were the reasons for the decision?
- What follow-up is planned, and who coordinates it?
- How do we get a complete copy of the labor, delivery and newborn records? Our medical records guide explains how to request them.
Sources
Every source below was opened and its title confirmed on the date shown. Sources are listed so you can read them yourself.
- Hypoxic Ischemic Encephalopathy — National Institute of Neurological Disorders and Stroke (NIH)
- Executive summary: Neonatal encephalopathy and neurologic outcome, second edition (2014) — ACOG Task Force on Neonatal Encephalopathy with the American Academy of Pediatrics; hosted by the Society for Maternal-Fetal Medicine
- Executive Summary: Neonatal Encephalopathy and Neurologic Outcome, Second Edition — Obstetrics & Gynecology — Obstetrics & Gynecology (ACOG journal)
- Fetal Heart Rate Monitoring During Labor | ACOG — American College of Obstetricians and Gynecologists