What is Hypoxic-Ischemic Encephalopathy (HIE)?

How does a baby with HIE act?

When will I know if there is permanent brain damage?

What kinds of long term problems are possible if there is permanent damage?

What is Hypoxic-Ischemic Encephalopathy (HIE)?
Hypoxic means too little oxygen. Ischemic means not enough blood flow. Encephalopathy means abnormal brain function. HIE means that for a period of time there was too little oxygen and blood flow to the brain. This causes the brain to act abnormal.

• The baby will have abnormal activity, either very irritable and tense or very low tone and little or no activity
• The baby may have seizures or abnormal movements
• The baby may not breathe normally or have apnea, a period of no breathing
• The baby may show signs of damage to other organs
• Kidney - too little or too much urine, blood in the urine, proteins in the urine, abnormal tests of kidney function (BUN and Creatinine)
• Liver- abnormal tests of liver function
• Blood - difficulty clotting blood
• Intestines - blood in the stool or necrotizing enterocolitis

When will I know if there is permanent brain damage?
Those caring for your baby will be best able to answer this question. Often the answer is known only over time. Babies are most like to have severe problems if they

• had abnormal EEG's in addition to the seizures on it
• take over two weeks to act like a normal baby or learn to feed normally
• continue to have very low tone

What kinds of long term problems are possible if there is permanent damage?
Serious abnormalities appear gradually. These may include:

• motor (movement) problems
• tight or stiff muscles
• holding legs straight and crossed most of the time
• difficulty sitting
• slow to crawl, stand, or walk or inability to do these
• abnormal crawling, toe walking
• frequent arching of the back (not just when angry or at play)
• one side weaker than the other

slow mental development
does not listen to your voice by age 3-4 months after hospital discharge
does not make different sounds by 8-9 months after discharge
doesn't seem to understand or say any words by one year after discharge

seizures
poor hearing or deafness
poor vision

Less serious problems appear more slowly, are more difficult to detect, and may not be obvious until preschool or grade school. These can include:

• poor coordination or balance
• specific learning disabilities (math or reading)
• very short attention span
• behavioral problems
• difficulty with activities that require coordination of the eyes and hands; for example, catching a ball or copying a simple drawing

It is very important for babies who have HIE to receive close follow-up of their development. If your baby has HIE, s/he may be eligible for a developmental intervention program, see Family Village. Anytime in the future if you are concerned about something that you think might be abnormal, have it checked out by your baby's doctor.

Source: University of Wisconsin and The Center For Perinatal Care at Meriter Hospital Madison, Wisconsin