Cerebral Palsy and Hypoxic Ischemic Encephalopathy
Cerebral palsy is caused by brain damage and the most common way that brain damage occurs while a baby is being born is through asphyxiation, or being deprived of oxygen. One of the most common types of oxygen deprivation is called hypoxic ischemic encephalopathy, or HIE. It is also known as intrapartum asphyxia. This kind of oxygen deprivation occurs during labor and delivery.
Like any other cause of oxygen deprivation, HIE leads to brain damage, and often to a disability like cerebral palsy. The degree of disability varies by individual and is highly dependent on how long the baby was lacking oxygen. About one out of ten cases of cerebral palsy, of any severity, is caused by HIE. Your child may be diagnosed with HIE at birth, and if so, you need to know what your treatment options are. There are some strategies that can be used to minimize the damage to your child.
What Is Hypoxic Ischemic Encephalopathy and When Does it Occur?
HIE is oxygen deprivation-caused brain damage that occurs during the perinatal period, in the weeks leading up to birth or during labor and delivery. It is most common in infants that are full-term, but may also happen in premature infants. The resulting brain damage may cause a variety of disabilities that depend on the area of the brain that was affected and the severity of the oxygen deprivation and resulting brain damage.
What Causes HIE?
The direct underlying cause of HIE is asphyxia. When oxygen is deprived for a significant period of time, there will be some degree of resulting brain damage. What causes the asphyxia is more complicated and may not be determined for every infant. Several possible causes include:
- Medical negligence.
- Heart complications.
- Placental abruption.
- A prolapsed umbilical cord.
- Labor and delivery stress.
- Maternal low blood pressure.
- Maternal blood that is low in oxygen.
- Umbilical cord complications.
- An intrapartum hemorrhage.
- Prolonged labor.
- Trauma to the brain or skull.
- Congenital brain defects.
- Maternal diabetes.
- Malformed lungs.
- Preeclampsia, or high blood pressure.
- An abnormal position of the fetus.
- Interrupted breathing.
- Uterine or vasa previa rupture.
Symptoms of HIE
The mildest cases of HIE may go with symptoms undetected and often resolve within 24 hours. Mild HIE may be characterized by poor feeding, excessive crying, irritability, or slightly increased muscle tone in the infant. More moderate HIE may cause lethargy, significantly low muscle tone, slow or absent reflexes, and even seizures. Infants with moderate HIE can recover or may end up with only mild disabilities.
Severe HIE usually leads to lasting disabilities and more severe disabilities. Infants with severe HIE may experience many of the above symptoms, but the seizures may not occur right away. When they do occur, seizures are likely to be worse and to resist normal treatment. Other symptoms of severe HIE include dilated pupils, no reaction to stimuli, irregular breathing, absent infant reflexes, irregular heart rate and blood pressure, stupor, and coma.
If your infant shows any signs of HIE after being born, or if there had been any kind of complication or trauma during delivery that may have caused HIE, there are tests that can be done to try to confirm the brain damage, to see where it occurred, and to determine the severity. These include imaging tests like MRIs that can image the brain to look for areas of damage.
Doctors also look at the pH of a sample of umbilical cord artery blood. If it is less than seven, this supports a diagnosis of HIE. They will also consider the infant’s Apgar score. This is a quick test that is done just a few minutes after a baby is born to evaluate the baby’s heart rate, reflexes, skin color, muscle tone, and breathing. The healthier the baby, the higher the score is. An Apgar score of three or less is also used as supporting evidence for HIE.
Recognizing the signs of HIE and getting a diagnosis as soon after birth as possible is crucial. There are treatments that can help, but they need to be administered in a timely manner. These include making sure the infant has adequate ventilation, possibly using a respirator to support breathing, maintaining a certain blood pressure, managing fluids, managing blood sugar levels, and treating any seizures. It is also important to avoid overheating the infant because this can worsen the condition and cause worse long-term outcomes.
While overheating can cause more harm, researchers have actually developed a treatment that uses cold temperatures to treat infants with HIE. Hypothermia, or “cooling therapy,” can be used to drop the baby’s temperature and limit the amount of lasting damage to the brain. Studies have shown that babies that have suffered moderate to severe HIE and that undergo this hypothermia treatment have better outcomes. It is thought that the cold temperatures slow the death of brain cells and prevent the formation of toxic substances in the brain that cause damage. For this treatment the infant is cooled to about 33 degrees Celsius for 72 hours.
Hypothermia treatment has been proven to be an effective way to limit the lasting damage and long-term disabilities that babies born with HIE experience. However, there is no cure for HIE and any baby may face disability because of it, regardless of treatment. The best way to avoid it is to prevent the damage in the first place. Doctors and parents can work together to ensure safe labor and delivery, even while not all complications can be foreseen. Regular checkups for the mother to maintain her health, monitoring the fetus during labor and delivery, and having trained and experienced health care practitioners on hand all help to prevent the kinds of complications that can lead to HIE.
HIE can lead to serious consequences for a baby and the family. Severe brain damage can lead to lifelong disabilities that limit a child’s quality of life and that may cause stress, financial problems, and other issues for a family. If your child suffered because of HIE during labor and delivery, you need to know your rights. Advocate for your child to be diagnosed and treated as quickly as possible and to find out if someone’s negligence contributed to your child’s brain damage. Consult with a birth injury lawyer or legal team that can help you understand what your and your child’s rights are, how you can seek justice or compensation, and what steps you need to take next to best provide for your child.