What is Hypoxic Ischemic Encephalopathy in Newborn (HIE)

Hypoxic ischemic encephalopathy is a brain injury that occurs in newborns when the brain does not get enough oxygen. It can result in temporary or permanent injury.

It can develop before, during, or just after birth. If this occurs, your baby will likely need further testing, monitoring, and treatment. This may require a transfer to a hospital that can provide more advanced care in a neonatal intensive care unit (NICU). HIE can be serious, leading to permanent disability or even death.

What are the causes?

This condition may be caused by:

• Low blood pressure in the mother.
• Heart or lung problems in the baby.
• Injuries to the baby during birth.
• A long and difficult delivery.
• Severe bleeding in the mother during birth.
• Umbilical cord problems during birth.
• A placenta that detaches from the uterus (placental abruption).
• A tear in the uterus (uterine rupture).

In some cases, what stops oxygen from reaching the brain is not known.

What are the signs or symptoms?

Signs and symptoms of HIE that occur while still hospitalized can be mild, moderate, or severe. They may include:

• Muscle weakness.
• Underactive muscle reflexes.
• Poor feeding.
• Irritability.
• Sleepiness or lack of energy (lethargy).
• Irregular breathing or a stop in breathing (apnea).
• Very weak and unstable heart rate.
• Weak and unstable blood pressure.
• Seizures.

Long-term symptoms may include:

• Recurrent seizures (epilepsy).
• Developmental delays, including learning problems.
• Permanent disabilities, including physical problems (cerebral palsy).

How is this diagnosed?

This condition is diagnosed based on the details of events around the time of delivery, the baby’s symptoms, and Apgar score. Apgar is a scoring system that tests a baby’s breathing, muscle tone, reflexes, heart rate, and skin color at 1, 5, and 10 minutes after birth. Your baby’s health care provider may suspect hypoxic-ischemic encephalopathy if:

• Your baby has signs and symptoms of the brain injury due to a lack of oxygen.
• Your baby’s Apgar score at 10 minutes after birth is lower than 5.
• Your baby has seizures.

Your baby may have other tests to confirm the diagnosis. These include:

• Electroencephalogram (EEG). This test detects electrical activity in your baby’s brain.
• MRI.
• A cranial ultrasound. This scans the brain using high frequency sound waves.

How is this treated?

This condition may be treated with:

• Steps to restore breathing and heartbeat (resuscitation). Newborns with this condition often require rescue soon after birth.
• Continued help with breathing. Additional oxygen may be needed.
• Fluids and medicine to keep blood pressure normal.
• Steps to control blood sugar and salt (electrolyte) balance.
• Medicine to control seizures.
• Therapeutic cooling. This is the standard treatment in moderate to severe cases. It is done within 6 hours of life. Your baby’s head or whole body is brought to temperatures lower than normal and closely monitored for 72 hours.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your baby’s health care provider.
• Make sure that your baby is up to date on all his or her vaccines. Your baby’s health care provider will tell you which vaccines are required.
• Do not give your baby aspirin because of the association with Reye syndrome.

General instructions

• Talk with your baby’s health care provider about using a home apnea monitor to check your baby’s heartbeat and breathing.
• Monitor your baby for seizures. Tell your baby’s health care provider if seizures begin to last longer than usual, or if they happen more frequently.
• Do not smoke and do not let others smoke around your baby. Secondhand smoke worsens your baby’s breathing problems.
• Make sure that anyone caring for your baby is trained in infant CPR.
• Follow the health care provider’s instructions on feeding your baby. In moderate to severe cases, your baby may require specialized feeding techniques.
• Keep all follow-up visits as told by your baby’s health care provider. This is important.
  • The health care team may need to monitor your baby for any problems in growth and health and provide early treatment if needed.

Contact a health care provider if your baby:

• Has problems feeding or gaining weight.
• Is irritable.
• Is lacking in energy and movement (lethargic).
• Has a fever.

Get help right away if your baby:

• Has apnea.
• Has a seizure.
• Has trouble breathing or turns blue.
• Is younger than 3 months and has a temperature of 100°F (38°C) or higher.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• Hypoxic-ischemic encephalopathy (HIE) is a brain injury that occurs in newborns when the brain does not get enough oxygen.
• Your baby may need testing, monitoring, and treatment in the NICU, which may require a transfer to another hospital.
• In severe cases, the baby’s injuries may become permanent. These injuries may lead to developmental delays or permanent disabilities.
• Follow the health care provider’s instructions about giving medicines, feeding your baby, giving the required vaccines, learning CPR, and keeping follow-up visits.