Hypoxic Ischemic Encephalopathy

The Doctors Mentioned Hypoxic Ischemic Encephalopathy (HIE)…What Is HIE?

What is hypoxic ischemic encephalopathy? For many parents, this word and condition is foreign, until they must deal with a birth injury. The best way to understand hypoxic ischemic encephalopathy is to break the word down into its three components. When you see the word hypoxic, or hypoxia, you should start thinking about a reduced level of oxygen. The word ischemic deals with blood flow. Finally, encephalopathy means an injury to the brain. Add the three words together and you get a reduced level of blood and oxygen leading to an injury to the brain. This is essentially what hypoxic ischemic encephalopathy means. The technical definition of hypoxic ischemic encephalopathy is a brain injury caused by asphyxia (deprivation of oxygen).

According to some data, hypoxic ischemic encephalopathy accounts for around 23% of neonatal deaths worldwide. Because of the serious nature of hypoxic ischemic encephalopathy, many parents have serious concerns regarding the challenges their child will face in the future.

Hypoxic ischemic encephalopathy at its basic level focuses on the lack of blood and oxygen in the tissue. When this occurs, developmental delays and other types of brain injuries can occur, like cerebral palsy.

What Are Some Of The Causes And Risk Factors For Hypoxic Ischemic Encephalopathy?

In the birth trauma context, there are multiple ways in which a baby can develop hypoxic ischemic encephalopathy. It is important for parents to remember that anything which can lead to a reduction in blood and oxygen in a baby can possibly lead to HIE. Some of the notable causes of hypoxic ischemic encephalopathy are as follows:

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Premature Birth

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Baby Suffers A Stroke (Before Delivery/During Delivery)

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Umbilical Cord Issues: Umbilical cord problems can lead to hypoxic ischemic encephalopathy because the umbilical cord delivers important nutrients to the baby. One of the biggest areas of concern with umbilical cord problems deals with cord compression. Cord compression can be seen in umbilical cord prolapse. Cord prolapse is a medical condition in which the umbilical cord drops out of the uterus before the baby. Compression can also occur with a knotted umbilical cord (just as the name suggests) and nuchal cord (umbilical cord wrapped around the baby’s neck).

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Shoulder Dystocia: During shoulder dystocia not only can the baby suffer injury to their arm and or hand, an injury to the brain can occur due to a compressed umbilical cord.

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Failure To Correctly Monitor Electronic Fetal Heart Monitor: Remember, the fetal heart monitor is watching the baby’s heart rate, among other things. It is with the help of the fetal heart monitor that doctors can determine whether the baby is suffering from fetal distress.

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Tachysystole: excessive and frequent contractions during delivery. Limits the resting period during contractions.

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Placenta/Uterus Problems: Uterine rupture is a serious childbirth event. In a uterine rupture, the wall of the uterus becomes compromised and the contents can spill into the abdominal cavity. A uterine rupture can reduce the amount of blood and oxygen to the baby, thus creating a fetal hypoxic situation. Placental abruption, the medical condition in which the placenta detaches from the uterus, can also cause hypoxic ischemic encephalopathy. Placenta previa can also cause hypoxic ischemic encephalopathy because of severe bleeding. In placenta previa the placenta covers the cervix, instead of growing on the top or side of the uterus.

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Baby Size & Delivery Position Issues: Cephalopelvic disproportion, a medical condition where the baby’s head is too big to pass through the pelvis, can cause HIE. In addition, a baby delivered in the breech position can lead to hypoxic ischemic encephalopathy. A breech baby is one that is delivered feet or buttocks first. Breech deliveries can lead to HIE because of umbilical cord compression, among other things.

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Forceps & Vacuum Assisted Deliveries: Assisted vaginal deliveries can be the reason for hypoxic ischemic encephalopathy. Head injuries can be the result of improper use of forceps or vacuum instruments.

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Failure Or Delay In Performing C-Section

How Can Parents Tell If Their Child Has Suffered From Hypoxic Ischemic Encephalopathy?

Even though a lot is usually going on during the labor and delivery of a child, parents can be alerted to problems along the way. In the context of hypoxic ischemic encephalopathy, parents may notice the following:

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Doctors Or Nurses Explaining A Non-Reassuring Fetal Heart Reading

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Meconium Stained Fluid

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Baby Is Blue In Color Following Delivery

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Seizures

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Baby Has To Be Resuscitated Followed By Handoff To NICU

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Baby Has Difficulty Feeding

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Multi Organ Issues (heart, lungs, kidneys, etc.…)

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Low Muscle Tone

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Low Apgar Scoring: Apgar scores are a way to determine the condition of a newborn baby. The scores (0-10) are generally done within the first minute after birth and then at the five-minute mark. Depending on the score, a ten-minute Apgar may be performed.

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Increased Uterine Stimulation: The use of drugs such as Pitocin

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Umbilical Cord Gas Reports

How Do Doctors Diagnose Hypoxic Ischemic Encephalopathy?

Hypoxic ischemic encephalopathy is a medical condition that is diagnosed with the help of imagining tests. When doctors suspect that hypoxic ischemic encephalopathy is a possible diagnosis, they will order tests such as MRIs and other types of neuroimaging. Specific tests such as diffusion weighted imaging and MR spectroscopy can help doctors arrive at the diagnosis. Some of these tests must be performed within a certain amount of time following the child’s birth to be effective.

When diagnosing hypoxic ischemic encephalopathy, it is important for doctors to watch for certain things in the child to get to the correct differential diagnosis. For example, if the child had meconium stained fluid, was blue in color at delivery, had to be rushed to the NICU, and suffered seizures, hypoxic ischemic encephalopathy should be a possible diagnosis to be ruled out.

What Types Of Treatment Are Available For Hypoxic Ischemic Encephalopathy?

Because many of the children who suffer from hypoxic ischemic encephalopathy go on to develop a subsequent cerebral palsy diagnosis, much of the treatment stems around occupational therapies to help the child. For many children who have suffered from hypoxic ischemic encephalopathy, the lack of blood and oxygen causes permanent injury to the brain. These types of injuries cannot be reversed.

A New Treatment For Newborns Suffering From HIE

Recently, a new treatment developed for babies who are battling hypoxic ischemic encephalopathy. This treatment is called Hypothermia Cooling, or brain cooling. The treatment looks to cool the baby’s body temperature to between 33.5 and 34.5 degrees Celsius. This treatment must be done within six hours of birth and must be done continuous for seventy-two hours. The goal is to lower the baby’s metabolic rate, thus helping injured cells and decreasing the severity of the injury.

Doctors must be alert for the possibility of hypoxic ischemic encephalopathy in newborns who demonstrate certain findings. Delay in diagnosing HIE, or not following the proper procedures for brain cooling, can lead to the baby losing out on important treatment.

Boston Law Group, LLC represents victims of birth injury and medical malpractice throughout Maryland. We can help victims in:

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Prince George’s County

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Montgomery County

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Baltimore City

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Baltimore County

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Anne Arundel County

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Howard County

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Charles County

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St. Mary’s County

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Allegany County

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Calvert County

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Caroline County

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Carroll County

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Cecil County

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Dorchester County

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Frederick County

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Garrett County

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Harford County

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Kent County

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Somerset County

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Talbot County

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Washington County

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Wicomico County

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Worcester County

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