Abbreviated as HIE, hypoxic-ischemic encephalopathy is a type of brain damaged caused by the loss of oxygen during labor or delivery. This condition occurs in approximately 1.5 to 2.5 of every 1,000 live births, and in 40 to 60 percent of cases, children die before their second birthday or suffer severe lifelong disabilities. This brain injury can have a number of different causes, but it’s often a result of a birth injury.
CAUSES OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY
Hypoxic-ischemic encephalopathy is caused when the brain can’t get enough oxygen. Newborns can survive for short periods of time without oxygen and their cells can repair themselves. Eventually, however, the lack of oxygen can lead to irreparable brain damage.
Hypoxic-ischemic encephalopathy can be caused by the following issues:
- Undeveloped infant lungs that can’t bring enough oxygen to the blood
- Cardiac issues that prevent oxygenated blood from reaching the brain
- Umbilical cord injuries
- Prolapsed umbilical cord
- Clotting of placental arteries
- Placental abruption
- Pressure to the scalp that compromises blood flow
- Breech presentation
- Shoulder dystocia
- Fetal stroke
- A birth injury related to medical negligence
- Maternal hypotension
- Maternal high or low blood pressure
- Maternal infection such as pelvic inflammatory disease
In many cases, these factors are caused or worsened by medical malpractice. If the nurses or attending physician fail to notice that the infant is in distress and not getting enough oxygen, for example, that negligence can lead to brain damage. Similarly, if a medical professional uses vacuums or forceps incorrectly or too forcibly, that can lead to a birth injury such as an infant stroke, which also deprives the brain of oxygen and potentially leads to serious issues.
HYPOXIC-ISCHEMIC ENCEPHALOPATHY SYMPTOMS
If an infant suffers from a stroke during or after birth, the parents and the medical team should look for signs of hypoxic-ischemic encephalopathy. Similarly, if oxygen is disrupted for any other reason, parents should also request tests for hypoxic-ischemic encephalopathy.
However, in some cases, there is no clear indication that an infant may have this condition, and in those situations, you should look for the following symptoms:
- Organ dysfunction (e.g. shutdown of the heart, lungs, kidney, or liver)
- Epileptic activity on electroencephalogram (EEG)
- Abnormal fetal heart rate
- Poor umbilical cord gases
- Low Apgar scores, especially if scores are low for more than 10 minutes after birth
- Meconium-stained amniotic fluid
- Inability to breathe right after birth
- Hypotonia (low muscle tone, often referred to as floppy baby syndrome)
- Inability to nurse
- Depressed level of consciousness for 7 to 14 days after birth
Note that when using imaging to detect hypoxic-ischemic encephalopathy, medical professionals need to be aware that the damage often gets worse over time. Additionally, as babies get older, they may also show impaired motor function and an inability to hit developmental milestones.
STAGES OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY
Hypoxic-ischemic encephalopathy has several different stages, depending on the extent of the damage. Here are the three main stages:
- Mild Hypoxic-Ischemic Encephalopathy—Infants struggle to feed, cry excessively, and are not as alert as they should be. These symptoms usually resolve themselves within 24 hours.
- Moderate Hypoxic-Ischemic Encephalopathy—Infants have low muscle tone with diminished reflexes. In particular, their grasping, sucking, and Moro (falling reflex) may not be apparent. They often have seizures in the first 24 hours after birth, but after that, they tend to have a full recovery within one to two weeks.
- Severe Hypoxic-Ischemic Encephalopathy—These infants start with the same symptoms as infants with moderate hypoxic-ischemic encephalopathy, but their seizures often worsen 24 to 48 hours after onset.
Eventually, with severe HIE, the seizures slow down, and the following symptoms begin to appear:
- Unresponsiveness to physical stimulus
- Irregular breathing and/or a need for respiratory support
- Irregular heartbeat or blood pressure
- Eyes don’t focus
- Eyes are unresponsive to light
- Constantly dilated pupils
CONDITIONS RELATED TO HYPOXIC-ISCHEMIC ENCEPHALOPATHY
When infants have severe hypoxic-ischemic encephalopathy, they may develop the following conditions:
- Cerebral palsy
- Periventricular leukomalacia (PVL)
- Developmental disabilities
In fact, according to numerous studies, 9 percent of cerebral palsy cases are related to lack of oxygen (asphyxia) during birth. PVL primarily happens in cases where preterm infants suffer from hypoxic-ischemic encephalopathy.
Worldwide, hypoxic-ischemic encephalopathy is responsible for about 23 percent of all neonatal deaths, making it one of the most common causes of neonatal deaths. Annually, this issue leads to about 840,000 newborn deaths.
TREATMENT FOR HYPOXIC-ISCHEMIC ENCEPHALOPATHY
Treatment for this condition can start immediately after birth or as soon as you realize that your baby is suffering from this particular birth injury. Right away, treatment involves improving blood flow and increasing the levels of oxygen in the blood to prevent further damage from occurring. This process involves adequate ventilation and blood pressure management.
Additionally, it’s critical to monitor electrolyte and glycemic levels, and some infants need anti-seizure medication. Researchers are actively looking for more effective ways to treat hypoxic-ischemic encephalopathy and prevent its symptoms from getting worse. Experimental treatment includes prophylactic barbiturates, low-dose erythropoietin, and stem cell therapy as well as other options.
Another treatment that some hospitals are trying is called brain cooling. In this treatment, the infant’s brain is cooled to just a few degrees below regular body temperature for three days. During this time the baby’s heart rate and brain activity are monitored closely. Babies often seem to be quiet and sleepy through this treatment, and they are fed intravenously. Eventually, the baby is warmed and receives additional treatment as needed.
The in-hospital treatment for this birth injury is just the beginning. Children who have suffered from hypoxic-ischemic encephalopathy may need lifelong treatment, medication, and assistance for physical and mental disabilities. In some cases, this injury causes the loss of the infant.
GETTING LEGAL HELP FOR HYPOXIC-ISCHEMIC ENCEPHALOPATHY
If your child has hypoxic-ischemic encephalopathy due to a birth injury or the negligence of the hospital or medical team, our Cleveland birth injury law