The 3 Stages of Hypoxic Ischemic Encephalopathy March 3, 2024.

The 3 Stages of Hypoxic Ischemic Encephalopathy

During labor, birth injuries can quickly turn joy into panic for the family. It is even more frightening when there is an injury that could be permanent. Sadly, many families experience this fear every day during labor.
Some startling statistics about birth injuries include:

  1. In Ohio, there were 7.06 infant deaths per 1,000 live births in 2021 (CDC)
  2. There are around 7 birth injuries per 1,000 live births
  3. In 2021 black babies had the highest mortality rate in the U.S., at 10.6 per 1,000 live births (CDC)

Even with advances in the healthcare industry, birth injuries still happen. Birth injuries can be temporary, like bruising, or permanent, like hypoxic-ischemic encephalopathy.

What Is Hypoxic Ischemic Encephalopathy?

Hypoxic ischemic encephalopathy, or HIE, is a type of brain damage that occurs before, during, or after birth. HIE is a very serious and life-threatening birth injury. According to The Cleveland Clinic, it is fatal for 20%-50% of babies. Out of the babies who survive HIE, 25%-60% of them will develop a neurological disorder.

Common Causes

HIE is caused by the lack of oxygen and blood to the baby's brain. When the oxygen and blood supply is cut off, the brain cells begin to die. The damage from the cells can lead to permanent brain damage.
The lack of oxygen can be caused by:

  1. Uterine rupture
  2. The mother having low blood pressure
  3. Excessive bleeding
  4. Shoulder dystocia
  5. The baby being in breech position
  6. Umbilical cord problems
  7. Preeclampsia

Diagnosing HIE

HIE is initially diagnosed through a series of physical exams. Doctors closely watch the baby for any signs or symptoms of HIE. Then, blood tests are performed to see if any organs were affected by the lack of oxygen. Doctors also use a Magnetic Resonance Imaging (MRI) machine to scan the baby’s brain. The MRI scan will show if there are any brain injuries.

The Three Stages of HIE

HIE is categorized into three stages, depending on how severe the brain damage is.
The three stages of HIE include:

  1. Stage 1: Mild
  2. Stage 2: Moderate
  3. Stage 3: Severe

How severe the condition is depends on how long the baby went without oxygen. The severity of the condition will also affect the prognosis and treatment options.
Continue reading to learn about the symptoms and prognosis of each stage of HIE.

Stage 1: Mild HIE

Symptoms that show in babies with mild HIE are mostly behavioral.
These symptoms include, but are not limited to:

  1. Excessive crying
  2. Bad temper
  3. Poor feeding
  4. Excessive sleepiness

In most cases, these symptoms will go away within 24 hours. If your child continues to have these symptoms, contact your doctor immediately.
The prognosis for babies with mild HIE is typically favorable. Generally, they will recover quickly, without any long-term complications. It is estimated that less than 5% of babies with mild HIE will be severely handicapped. With mild HIE, most children are expected to be able to live long and happy lives.

Stage 2: Moderate HIE

Common symptoms in newborns with moderate HIE include:

  1. Poor or delayed reflexes
  2. Excessive sleepiness
  3. Seizures
  4. Apnea (Pauses in breathing for 20 or more seconds)
  5. Weak cry

Babies with moderate HIE may have life-long mental or physical disabilities. According to the Florida Neonatal Neurological Network, 25%-75% of babies will have a disability. Unfortunately, moderate brain damage also increases the chances of the newborn passing away early.
One thing to note is that there are treatments that can improve brain damage in babies with moderate to severe HIE. The treatment is therapeutic hypothermia. We will explain what this treatment is later in the article.

Stage 3: Severe HIE

The symptoms of severe HIE are very different from other stages. These symptoms are more intense and require immediate medical intervention.
Symptoms of severe HIE include:

  1. Seizures
  2. Coma
  3. Fast heart rate
  4. Irregular breathing
  5. No reflexes (grabbing, sucking, etc.)
  6. Weak muscle tone
  7. Heart rate issues
  8. Blood pressure problems

Severe HIE is extremely life-threatening if it is not quickly treated. Sadly, up to 75% of newborns with this condition will have a mental impairment or will pass away.

Every case of HIE is serious and can be life-threatening without medical intervention. If your baby shows any symptoms of HIE, it is important to contact their doctor as soon as possible.

Treatment Options

Therapeutic hypothermia is an effective treatment for HIE. You may be thinking about how dangerous hypothermia is. Normally it is very dangerous. But, when it is controlled it has very positive effects on babies with HIE.

Therapeutic hypothermia is the process of cooling a baby's body, in order to slow down cell activity. This allows the brain cells to heal and minimize brain damage.

The longer the baby goes without treatment, the more cell damage will occur. This treatment should be done within the first six hours after birth for the child to have the best outcome.

Therapeutic hypothermia is proven to decrease the chances of babies having physical or mental disabilities.

Other treatments include being on a ventilation system if they are having difficulty breathing. Some babies may also need anti-seizure medication, in addition to therapeutic hypothermia. The baby should be closely monitored to make sure that their condition does not get worse.

What To Do if Your Baby Was Affected By HIE

In some cases, HIE can be prevented with proper monitoring of the baby. If your baby developed HIE due to a doctor’s or nurse's negligence, you have the right to hire an attorney. It is important to recover compensation for your baby's injuries to help pay for life-long treatment, medication, and physical assistance.

Contact the Birth Injury Attorneys at The Mellino Law Firm

Christopher Mellino has spent 40 years fighting for families who were affected by birth injuries. He has obtained millions of dollars in compensation for families, which will allow them to give their children the proper medical care. During his career, Chris has received record-setting verdicts for victims of medical malpractice and birth injuries. Notably, Chris recovered a $28.7 million verdict in a birth injury case.

Chris is also the author of the book Was It a Mistake? Your Ohio Medical Malpractice Questions Answered. Download our free in-depth guide to medical malpractice in Ohio.

At The Mellino Law Firm, we are dedicated to getting justice for the children and families who have had to go through birth injuries. Contact our Cleveland-based office at (440) 333-3800 or fill out our quick contact form for a free case evaluation.