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What Parents Need to Know About Hypoxic-Ischemic Encephalopathy (HIE) in Newborns

Welcoming a new baby should be a time of joy, but for some families, it can be overshadowed by unexpected birth complications. One of the most serious conditions that can affect newborns is hypoxic-ischemic encephalopathy (HIE).

HIE is a brain injury that is usually caused by a lack of oxygen or reduced blood flow before, during, or just after birth. For an affected newborn’s family, understanding HIE’s causes, symptoms, and lifelong implications can be overwhelming.

Whether you’re facing a recent diagnosis or just trying to get informed before your due date, this guide will help educate you on what HIE is and what legal options are available to you.

What is Hypoxic-Ischemic Encephalopathy?

Hypoxic-ischemic encephalopathy (HIE) is a medical term that describes when a baby’s brain does not get enough oxygen (hypoxia) or blood flow (ischemia) around the time of birth. The result is damage to brain tissues, which can range from mild and temporary to severe and permanent.

Put simply, HIE in newborns is essentially “oxygen deprivation during birth leading to brain injury.” The condition varies widely in seriousness and outcome, often requiring urgent medical attention and (in many cases) lifelong support.

What Is Hypoxia and Ischemia?

Hypoxia: Lack of oxygen to body tissues, including the brain, which can cause cells to become damaged or die.
Ischemia: Reduced or blocked blood flow. When the brain does not get the nutrients and oxygen it needs from the blood, injury can occur.

When both hypoxia and ischemia happen together (before, during, or after birth), the brain can suffer significant damage. The condition is sometimes called “birth asphyxia,” which means oxygen deprivation at birth.

How Common Is HIE in Newborns?

HIE is considered a rare condition, but it still affects thousands of families each year. Hope For HIE recently reported that in the United States, HIE occurs in roughly 1 to 3 per 1,000 live births. In regions with fewer medical resources, the incidence may be much higher, close to 26-30 per 1,000 live births.

The Causes of HIE in Newborns

There isn’t a single reason why HIE occurs. However, there are multiple factors, before, during, or even after childbirth, that may contribute to a higher chance of HIE.

Factors that contribute to HIE during fetal development include:

Preeclampsia (high blood pressure in pregnancy)
Vascular disease (issues with mother’s blood vessels)
Placental abruption (when the placenta detaches unexpectedly)
Fetal anemia (low blood count)
Maternal diabetes
Uterine rupture
Fetal infection
Lung malformations in the fetus
Maternal drug or alcohol use

Factors that contribute to HIE during labor and delivery include:

Umbilical cord prolapse (cord slips ahead of baby)
Umbilical cord compression (the cord squeezed or flattened)
Placental abruption
Failure to monitor baby’s heartbeat closely
Breech presentation (baby is born feet-first)
Shoulder dystocia (baby’s shoulders are stuck during birth)
Fetal stroke
General delivery complications
Failure to perform a timely C-Section

Factors in the newborn that contribute to HIE during the postnatal period include:

Lung or heart disease in newborns
Infection after birth
Brain or skull trauma
Low blood pressure
Respiratory failure (baby can’t breathe properly)
Hypoglycemia (low blood sugar)
Hyperglycemia (high blood sugar)

It’s critical for parents to note that many incidents of HIE happen because healthcare providers miss warning signs or make preventable mistakes before, during, and after birth. Timely and appropriate care is essential; when medical professionals fail to act quickly or correctly, a baby is at risk for serious injury.

Good prenatal care, diligent monitoring during labor, and quick response to complications are key to mitigating the potential for HIE to arise. Not all HIE cases are preventable, but many arise from treatable problems that can be avoided by informed parents and careful medical professionals.

Signs and Symptoms of HIE Parents Should Watch For

Early identification of HIE is vital. Symptoms vary depending on severity. Some can appear soon after birth, with more obvious urgency. Other signs are subtle and may appear later in the baby’s development.

Mild or moderate symptoms of HIE in newborns include:

Floppy, weak muscle tone (hypotonia)
Tense muscles (hypertonia)
Difficult feeding
Fatigue
Irritability
A weak cry
Pale, blue or gray skin tone (cyanosis)

Severe symptoms of HIE in newborns include:

Little to no response to touch or sound
Poor reflexes
Abnormal breathing patterns
An irregular or slow heartbeat
Seizures
Loss of consciousness

Any of these symptoms requires immediate medical attention. Even milder signs can indicate a brain injury that, if left untreated, may get worse. If your child experiences any of these signs or symptoms, call 911 or your local emergency services number.

Long-Term Outcomes of HIE

Not all cases of HIE have the same outcome. Some babies recover fully while others face lasting challenges. The impact can range from mild developmental delays to severe lifelong disabilities, and some children may need ongoing support well into adulthood.

Conditions that may result from HIE include:

Seizure disorders: Some children develop epilepsy or other ongoing seizure conditions.
Cognitive/developmental delays: This manifests through learning disabilities, speech difficulties, and memory issues.
Motor and sensory impairments: Trouble with movement or coordination, and hearing or vision loss are typical sensory impairments from HIE.
Cerebral palsy: This refers to a group of disorders affecting movement, balance, and posture. HIE is a leading cause of cerebral palsy. We have compiled a more comprehensive guide on navigating cerebral palsy injuries with information and legal help if you’re seeking a birth injury lawyer.

HIE and Medical Malpractice

Many tragic outcomes occur when doctors, nurses, or hospitals fail to follow the proper standard of care during labor and delivery.

Because HIE is usually the result of oxygen deprivation, quick action by medical professionals is critical. When warning signs are missed or ignored, the consequences for a newborn can be devastating.

Some of the most common forms of negligence that may lead to HIE include:

Failure to monitor fetal distress. If heart rate monitors show that a baby is struggling, doctors must act quickly. Ignoring or misinterpreting these signs can allow brain injury to develop.
Improper response to complications. Umbilical cord issues, placental abruption, or prolonged labor require immediate medical intervention. Delays or mistakes may result in permanent harm.
Delayed C-section. In many emergencies, an immediate C-section is the safest option. When providers wait too long to perform surgery, the baby may suffer irreversible brain injury.

When medical malpractice causes HIE, families may face a lifetime of medical expenses, therapy, and emotional strain. Pursuing a claim with an experienced birth injury lawyer can help secure compensation for long-term care and hold negligent providers accountable. A knowledgeable birth injury attorney can review medical records, identify mistakes, and fight for justice on behalf of your child.

You can learn more or seek immediate help from our HIE malpractice attorneys.

What Parents Can Do Next

If your baby is showing any potential signs of a brain injury, decisive action can change the future. The first and most important step is to seek immediate medical evaluation to confirm or rule out hypoxic-ischemic encephalopathy, and then begin essential treatment as early as possible. Timely intervention is vital for the best possible outcome.

But taking action doesn’t end at the hospital. HIE is a life-changing diagnosis for the whole family, but with the right kind of support, there is hope. Skilled legal counsel plays a critical role in helping parents understand their rights, investigating potential medical malpractice, and securing resources for an affected child’s lifelong care.

Parents who are well-informed and proactive can make a difference in their child’s recovery and future.

Wais, Vogelstein, Forman, Koch & Norman, LLC, has extensive experience standing up for families facing HIE. Our HIE lawyers are dedicated to protecting children, holding healthcare professionals accountable, and helping families get compensation for medical expenses and therapy.

Take the next step: call 410-998-3600, or contact us online for a free consultation with a knowledgeable attorney who can offer honest answers and strong advocacy.