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Hypoxic-ischemic encephalopathy (HIE) is a dangerous condition that happens when your brain doesn’t get enough blood and oxygen. It’s common among newborns who experience a difficult birth. It can be fatal or cause permanent brain damage in severe cases.
Hypoxic-ischemic encephalopathy (HIE) is a brain injury that occurs when your brain doesn’t get enough blood and oxygen. This can permanently change how your brain functions. HIE usually affects newborns who had a difficult birth, but it can also affect older children and adults who experience severe respiratory distress like drowning.
HIE is a life-threatening condition. Call 911 or seek medical attention right away if you or your child have symptoms of HIE.
You may hear your newborn’s healthcare provider refer to HIE as:
A healthcare provider will grade HIE based on your child’s prognosis. These include mild, moderate or severe. These grades can affect neurological outcomes. All grades of HIE require emergency medical attention to prevent life-threatening complications. Your healthcare provider can best explain your child’s outlook so you know what to expect.
HIE affects an estimated 1 to 6 infants out of every 1,000 births. In the United States, this equals about 9,000 to 12,000 newborns each year.
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Mild and moderate signs and symptoms of HIE in newborns include:
Severe symptoms of HIE in newborns include:
If your child experiences any of these signs or symptoms, call 911 or your local emergency services number. Even mild HIE is an emergency and requires immediate medical attention.
An interruption of blood and oxygen supply to your brain causes HIE. There are several ways that this could happen.
Causes of HIE during fetal development include:
Pregnant parents who experience a difficult pregnancy or delivery may be more at risk of having a child with HIE. Examples may include:
Causes of HIE in older children and adults may include events that make breathing difficult (respiratory distress) like:
An infant may be more at risk of HIE if they have:
A pregnant parent has a higher risk of delivery complications if they experience the following:
HIE is a serious condition that can be fatal. It can also lead to complications caused by permanent brain damage, including:
Many complications don’t appear until around the time your child starts school. If you notice your child misses developmental milestones or struggles in the classroom, contact their healthcare provider.
As HIE is a medical emergency, healthcare providers look for signs of the condition before and after your baby is born to make sure their brain receives enough oxygen and blood. If your baby experienced a difficult birth, healthcare providers prepare to treat this condition immediately, often before making an official diagnosis.
To diagnose hypoxic-ischemic encephalopathy, a healthcare provider will perform a complete physical exam. They’ll look for signs and symptoms of the condition and run tests to confirm a diagnosis.
For HIE in babies, tests may happen before your baby is born and after, including:
Additional blood tests may help your healthcare provider understand more about how HIE affected your newborn’s organs.
A healthcare provider treats HIE by:
If complications arise as your child grows, they may need additional support like:
Antiseizure medications may have side effects. They vary based on which one your healthcare provider prescribes. Before treatment begins, talk to your child’s healthcare provider about the possible side effects of treatment and what signs to look out for. Therapeutic hypothermia can also have side effects, such as low platelets.
Newborns with mild symptoms and no brain damage will make a full recovery in about two weeks. More severe cases can cause lifelong complications that need long-term management to help you or your child feel better.
There isn’t a way to prevent all cases of HIE.
You can reduce your risk of having a child with HIE by visiting your pregnancy care provider for regular checkups during pregnancy. Your healthcare provider can give you advice on how you can stay safe and maintain good health. Unfortunately, HIE can still happen even if you’re in good health during pregnancy.
It’s also important to manage substance use disorder to prevent complications that may affect you and your baby.
Older children and adults can prevent HIE by taking safety precautions before participating in potentially dangerous activities. For example, only swim in areas where there’s a lifeguard on duty to prevent drowning.
The severity of HIE can affect your newborn’s outcome. Research estimates that HIE is fatal for 20% to 50% of infants. An estimated 25% to 60% of infants have long-term neurological (brain and nerve) conditions like cerebral palsy or epilepsy or issues with cognitive function (learning disability).
Yes, a full recovery after HIE is possible in some cases. Prompt HIE treatment can prevent brain damage, leading to the best outcome. Unfortunately, not all babies make a complete recovery.
Severe HIE shortens life expectancy. A newborn may die during infancy or early childhood if they have severe brain damage. Mild HIE usually doesn’t affect how long you live. Moderate HIE may or may not shorten your life expectancy. Most infants with mild to moderate HIE have a normal life expectancy. Supportive treatment is available to reduce your baby’s risk of life-threatening outcomes.
Contact your child’s healthcare provider if they miss developmental milestones for their age or show signs of complications as they grow. If your child has trouble feeding, contact their healthcare provider.
Contact 911, local emergency services or visit the emergency room if you, your child or a loved one have signs or symptoms of HIE including:
Hypoxic-ischemic encephalopathy (HIE) can be a devastating and scary diagnosis for a new parent. You may feel worried and helpless as your newborn’s care team works around the clock to make sure your child’s brain receives enough blood and oxygen. During this time, your healthcare provider will keep you updated on how your child is doing and they’ll be available to answer any questions you might have. It helps to surround yourself with a strong support system of family and friends or speak with a mental health professional to help you navigate this challenging experience.
Last reviewed by a Cleveland Clinic medical professional on 09/08/2023.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy