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What is Hypoxic-Ischemic Encephalopathy or HIE?

Hypoxic-ischemic encephalopathy affects children before or during the birth process. In this guide, we’ll cover everything you need to know about HIE, including its causes, symptoms, diagnosis, prognosis, treatment, and related conditions. We’ll also connect you with community and legal resources that can help if a loved one has been affected by HIE.

This information has been compiled from government sources, medical sources, and from consulting with experts on hypoxic-ischemic encephalopathy.

If you’re dealing with the effects of HIE and want to know more details about this type of injury, Brown Trial Firm is ready to help. This comprehensive guide will cover everything you need to know about HIE, from its causes to symptoms to treatment.

If you believe your child’s HIE diagnosis is the result of medical malpractice, Brown Trial Firm may be able to help you. Please contact us today for a free consultation and to learn more.

Keep reading to learn more.

What is HIE?

Birth injuries can be very traumatic experiences for parents and children alike. One common type of birth injury is hypoxic-ischemic encephalopathy, which affects around 1 to 2 per 1,000 live births.

Before one can understand what HIE is, one will need to understand exactly what constitutes a birth injury.

A birth injury is simply any harm that a baby could experience shortly before, during, and immediately after birth. It can occur in premature or full term pregnancies.

HIE, also known as hypoxic-ischemic encephalopathy, is widely considered a type of birth injury or brain injury. It is a form of brain damage that occurs within newborns and fetuses. HIE is caused by deprivation of oxygen and, as a result, obstructed blood flow to the brain.

You may have also heard HIE by one of its other names, which include birth asphyxia, perinatal asphyxia, and neonatal encephalopathy.

Unfortunately, permanent brain damage as the result of HIE is not curable. Still, there are treatments and numerous forms of therapy that can reduce more problematic symptoms and help children with HIE function.

What Makes HIE So Dangerous?

Sometimes the damage inflicted on a baby with HIE isn’t known quickly. This is because HIE can be difficult to diagnose when it occurs.

There are several reasons for this. A brain injury caused by HIE develops over a process. Blood pressure builds and oxygen is blocked from entering the brain. The brain cells begin to die and release toxic matter which will then damage other cells around them. HIE is dangerous because even if the cause of the injury is caught, this cycle of brain damage may continue for hours or even days.

Additionally, the extensive damage from HIE may not even be noticeable until developmental issues begin to occur later in the child’s life. There are many symptoms of HIE, but not all of them are extremely common or very apparent shortly after birth. A parent may notice that their child isn’t crawling or standing around the time they should be. Infants can be diagnosed with HIE as late as nine months after their birth.

Although tragic, the nature of HIE does provide some insight into how medical professionals must remain alert and follow the standard of care when delivering a baby. 

What Causes Hypoxic-Ischemic Encephalopathy?

There are many different potential causes of hypoxic-ischemic encephalopathy. These causes usually occur shortly before, during, or after the birth. Medical malpractice could possibly play a role as well.

Here are a few of the potential causes of HIE:

  1. Umbilical cord issues. The umbilical cord is a key part of pregnancy. It is how the baby is able to receive nutrients, vital cells, dispel waste, and gain oxygen from the mothers.Sometimes, the umbilical cord can become compressed or its ability to function is significantly impaired. This is can be due to an injury or preexisting medical problem. As a result, the baby may be at a higher risk of HIE. 
  2. Complications and malformation of the baby’s heart.
  3. Extensive or prolonged labor when a C-section should have been performed.
  4. Abnormal positioning of the fetus during gestation.
  5. Issues with the mother. This can include low-oxygen blood, low blood pressure, diabetes, uterine rupture, and hemorrhages.
  6. Neonatal problems. The first month of a baby’s life outside of the womb can also be a factor in an HIE diagnosis. Respiratory problems and blood sugar diseases can contribute to HIE if those illnesses are not properly managed by parents and their doctor.
  7. Labor and delivery stress or problems.
  8. Placenta damage.
  9. Medical malpractice. If medical professionals do not properly monitor the pregnancy or catch signs of fetal distress during labor, the result could be HIE.Alternatively, if medical professionals observe signs of HIE but do not act quickly to treat the underlying cause of HIE, that delay can also cause injury.

Common Symptoms of HIE

Most symptoms of HIE are not found until after the baby is born, though doctors may be able to detect issues with the fetus if it is sending fetal distress signals during gestation.

Some common symptoms of HIE include:

  • Blood flow and blood pressure problems
  • Low pH blood
  • Little muscle tone
  • Seizures
  • Breathing and respiratory problems
  • Low heart rate
  • Unresponsive reflexes and lethargy
  • Feeding problems or issues with the umbilical cord
  • Pale skin
  • Vaginal bleeding in the mother
  • Symptoms similar to cerebral palsy
  • Placenta abruption

It’s important to note that in very mild HIE cases, symptoms may resolve in less than a day. Severe HIE could lead to long term disabilities.

Hypoxic-Ischemic Encephalopathy – Screening and Diagnosis

If for whatever reason you believe your baby is suffering from HIE, it is extremely important to seek medical attention. Usually, after a complicated delivery, doctors will perform tests to confirm the brain damage, see where it happened, and determine how severe a case of HIE your baby has.

After most births, an APGAR test is done to determine the acidity of the umbilical cord artery. This can determine a diagnosis of HIE and it is routinely done after a majority of live births to assess the child’s overall health. This should be performed within 24 hours of birth. However, because of the somewhat subjective nature of the APGAR test, it can be an unreliable method of diagnosing birth injuries.

If you suspect your child may have a birth injury, you should speak with your doctor about additional tests and monitoring.

Treatment for HIE

As mentioned previously, it is difficult to diagnose HIE on the spot because even if the injury is stopped or the obstruction is removed, the cycle of brain cell death can continue for days. If a medical professional suspects that the injury incurred during the labor and delivery process could lead to HIE, they could conduct something called therapeutic hypothermia.

Therapeutic hypothermia or “cooling therapy” is done by dropping the infant’s body temperature and reduce the extent of long-term damage to their brain. It is believed that cold temperatures can slow down the death of the brain cells post-injury and prevent toxic matter from “infecting” other healthy cells. 

In addition to therapeutic hypothermia, there are a number of other treatments available. These can include respiratory aids to help with breathing, blood pressure maintenance, blood sugar maintenance, seizure treatment, and proper ventilation.

What is the Life Expectancy for Someone with HIE?

Unfortunately, the wide range of symptoms and brain damage that could result from HIE make it impossible to pinpoint an exact life expectancy number. HIE could also cause additional health problems that could affect the child’s lifespan, such as Cerebral Palsy.

Overall, a mild cause of HIE can have little effect on a person’s lifespan. Severe HIE is another story. For those who cannot move easily and may have to be fed via a tube, life expectancy can be significantly reduced. However, this also depends on the overall quality of care (medically and physically) the patient receives.


Allen, K., & Brandon, D. (2011). Hypoxic Ischemic Encephalopathy: Pathophysiology and Experimental Treatments. Newborn And Infant Nursing Reviews, 11(3), 125-133. doi:10.1053/j.nainr.2011.07.004

UpToDate. (2019). Uptodate.com. Retrieved 18 November 2019, from https://www.uptodate.com/contents/clinical-features-diagnosis-and-treatment-of-neonatal-encephalopathy

Help for Children with HIE – Brown Trial Firm. (2019). Brown Trial Firm. Retrieved 18 November 2019, from https://browntrialfirm.com/hypoxic-ischemic-encephalopathy-hie/

Hypoxic-Ischemic Encephalopathy, or HIE, also known as Intrapartum Asphyxia. (2019). cerebralpalsy.org. Retrieved 18 November 2019, from https://www.cerebralpalsy.org/about-cerebral-palsy/cause/hypoxic-ischemic-encephalopathy

About Brown Trial Firm

Getting help for a child with HIE or Cerebral Palsy can make a big difference. Because early intervention is often key to helping improve a child’s wellbeing, it’s important to act swiftly.

At the Brown Trial Firm, our birth injury attorneys can help you investigate your case, find answers to your questions, and determine whether you are entitled to compensation. 

We offer case reviews at no cost or obligation. Many birth injuries that cause cerebral palsy could have been prevented. Don’t wait, get help today. Call us toll free at +1 (866) 223-7465 or email us a [email protected].

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