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Hypoxic-Ischemic Encephalopathy in Hawai'i

Perinatal asphyxia — known as hypoxic-ischemic encephalopathy or HIE — is responsible for nearly a quarter of all neonatal deaths around the world. This relatively common condition occurs in approximately one to six of every 1,000 live births, and 20 percent of children with HIE die as newborns.

Despite significant advances in knowledge about serious conditions affecting newborns, HIE remains a devastating condition that causes a significant number of deaths. Of the babies who survive, up to a quarter suffer severe disabilities, including motor or cognitive impairment. Complications of the condition can include epilepsy and seizures, cerebral palsy, vision and hearing loss, behavioral issues, learning disabilities, and failure of organs including liver and kidneys.

If you believe that your infant has been affected by hypoxic-ischemic encephalopathy at birth, it’s vital that you consult with a knowledgeable birth injury attorney to evaluate your case. Understanding the symptoms, treatments and potential outcomes for HIE is the first step.

Symptoms of Hypoxic-ischemic Encephalopathy

In mild cases of HIE, an infant may show slightly increased muscle tone and deep tendon reflexes. Various behavioral aberrations — including excessive fatigue or crying, poor feeding or irritability — may appear. These mild symptoms typically resolve in approximately 24 hours.

In moderate cases, infants demonstrate lethargy and decreased deep tendon reflexes. Occasional periods of apnea may appear, and the infant may exhibit sluggish or absent grasping and sucking reflexes. In many cases, seizures are apparent within 24 hours after birth. Infants with moderate symptoms may recover within one to two weeks.

Severe cases may include delayed seizures that do not respond to typical treatments. The frequency of the seizures may increase during the 24 to 48 hours following the initial onset. Infants with severe HIE may exhibit even less wakefulness and may suffer increased brain edema.

Coma often occurs in severe cases, and the baby may not respond to most physical stimuli. The child may exhibit irregular breathing and may require ventilation support, and depressed tendon reflexes commonly occur. Typical reflexes such as grasping, sucking and swallowing do not occur.

In addition, babies with severe HIE may exhibit eye movement disturbances, and the pupils may dilate or react poorly to light. Blood pressure and heart rate irregularities are common, and infants with severe cases may die from cardio-respiratory failure.

HIE symptoms can be mistaken for other conditions, including infections such as sepsis, genetic metabolism defects, other types of seizures, and stroke. If your child exhibits symptoms of HIE, it is important that medical professionals rule out other possible causes that may be either treatable or life-threatening.

Diagnosing the Condition

To diagnose hypoxic-ischemic encephalopathy, a medical professional should determine that several factors are present, including seizures or coma, the involvement of multiple organs, and persistence of an Apgar score of 0 to 3 for more than five minutes.

In addition, a number of tests and studies are used to diagnose the condition. Lab tests including renal function, serum electrolyte levels, coagulation system, cardiac and liver enzymes, and arterial blood gas are used. Imaging studies may include echocardiography, cranial ultrasonography, and brain magnetic resonance imaging.

A hearing test, ophthalmic and retinal exam, and standard and amplitude-integrated electroencephalograph also may be used.

Treating and Managing Hypoxic-ischemic Encephalopathy

Once an infant with HIE is initially resuscitated and stabilized, treatment involves supportive therapies, including management of blood pressure and fluids, adequate ventilation, and avoidance of hyperglycemia, hypoglycemia, and hyperthermia. In addition, treatment is administered for seizures.

Newborns with the condition typically are transferred to an intensive care nursery, with treatment divided into immediate management and long-term care. Immediate treatment includes catheters for blood pressure and blood gas monitoring, support of respiratory needs, seizure medications, fever control, and other measures.

Long-term treatment may include seizure medications along with occupational, speech, physical, and behavioral or cognitive therapies. In addition, special education and assistive devices may be required.

What Outcomes Can Be Expected?

The long-term prognosis for infants with HIE depends on the severity of the condition and the areas of the brain affected. Children with mild forms of the condition may have normal motor and neurocognitive functioning, while severe cases may result in early death or poor outcomes for babies that survive.

Outcomes for children with moderate forms of the condition can vary significantly; MRI can prove useful in predicting future functioning for children in this group. In some cases, cognitive impairment may not appear until children reach school age. Ongoing screening should be conducted to spot and treat any symptoms early.

Work With an Experienced Hypoxic-ischemic Encephalopathy Attorney

Dealing with the effects of HIE can be emotionally devastating for parents, and treating the condition can have significant financial consequences for many years. If you believe that a medical error or birth injury may have contributed to your child’s condition, you may be entitled to compensation that can help with medical bills and other costs. To speak with an experienced attorney, please contact Davis Levin Livingston.


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