What Is Hypoxic Ischemic Encephalopathy (HIE) and What Causes It?


Understanding the Primary Causes of HIE

Hypoxic ischemic encephalopathy (HIE) is a condition that can occur in babies who are deprived of oxygen during or near the time of birth. Hypoxia is a term used to describe a lack of oxygen in the tissue, and ischemia means a lack of blood flow to the tissues. Hypoxia and ischemia can occur independently, but hypoxia in and of itself causes ischemia due to the cascade of events that occur when a baby is hypoxic. When a baby experiences significant hypoxia and ischemia, brain injury starts to occur. When the brain swells as a result of this injury, it is called encephalopathy.

HIE, then, is a term used to describe brain injury and swelling that is caused by a lack of oxygen (and lack of blood flow) to the brain. If appropriate treatment and supportive care are given to a baby with HIE, permanent brain damage can be minimized or prevented.

What Conditions Can Result in HIE?

When mismanaged, these conditions can result in HIE:

  • Umbilical cord problems, such as nuchal cord (cord wrapped around the baby’s neck), umbilical cord prolapse, short cord, true knot in cord
  • Uterine rupture
  • Placental abruption
  • Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
  • Intrauterine Growth Restriction (IUGR)
  • Premature Birth (failure of the obstetrical team to take necessary steps to prevent premature birth)
  • Shoulder dystocia (baby’s shoulder is stuck in the birth canal, which can result in umbilical cord compression, prolonged labor / delivery, and head trauma / brain bleeds)
  • Preeclampsia / eclampsia
  • Oligohydramnios
  • Placenta Previa
  • Prolonged and arrested labor
  • Cephalopelvic disproportion (CPD – mismatch between the size of the baby and the size of the birth canal)
  • Macrosomia (large baby)
  • Post-term or post-date pregnancy (pregnancies that go beyond approximately 40 weeks)
  • Abnormal presentation, such as breech presentation, face presentation, brow presentation, limb presentation, occipitoposterior position (OP), shoulder presentation or transverse lie

Improper medical treatment of a baby can also result in HIE:

  • Improper use of Forceps or Vacuum Extractor during delivery (which cause a brain bleed)
  • Improper use of Pitocin and/or Cytotec for labor
  • Improper management of a baby’s breathing after birth (failure to give appropriate doses of Surfactant to premature babies, delayed intubation, delayed use of CPAP, improper settings on the baby’s breathing machine, failure to prevent frequent apneic and bradycardic events (failure to prevent events whereby baby has periods where she stops breathing and her heart rate slows down))

The labor and delivery and in-utero conditions discussed above can cause oxygen deprivation in a baby, and what is known as “fetal distress.” When a baby is in distress, the fetal heart tracings will be abnormal or nonreassuring. During labor and delivery – and often prior to labor (at the ER and obstetrical office visits) – the obstetrical team is supposed to monitor the baby’s fetal heart tracings very closely. If the baby is in distress, prompt action must be taken. The obstetrical staff sometimes tries conservative management of the distress initially. This may mean that the staff gives the mom fluids, repositions her, or gives her amnioinfusion if her amniotic fluid is low (called oligohydramnios). Many times, however, the oxygen deprivation that is making the baby distressed is very serious and the baby therefore must be delivered quickly, often by emergency C-section.

If fetal distress is recognized in an office setting, the mother should be rushed to the labor and delivery unit of a qualified and close hospital, and the obstetrical team should call ahead to tell the hospital what to expect so they are prepared.

When a baby is experiencing oxygen deprivation / distress, the staff must either promptly manage the condition that is causing the deprivation so that the deprivation ceases to occur, or they must emergently deliver the baby to get her out of the oxygen depriving conditions.

Our Medical Malpractice Team Is Here to Help

If your baby was diagnosed with hypoxic ischemic encephalopathy (HIE), or if your baby experienced a traumatic birth, oxygen deprivation, a brain bleed, delayed delivery, or delayed emergency C-section, please contact our team of experienced Michigan birth injury attorneys. The medical malpractice team at Grewal Law PLLC is composed of attorneys and healthcare professionals, including an on-site registered nurse, pharmacist, paramedic, and respiratory therapist. We also work with the best consultants from around the country, as well as an on-site physician. Our attorneys are licensed in Michigan and Florida, and we help victims of medical malpractice and birth trauma throughout Michigan and Florida.

Our medical malpractice attorneys and medical staff are available to speak with you 24/7. Contact us today at (888) 211-5798!

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