One matter that is of high importance that is currently pending on my office is about a boy that sustained an injury on his brain due to the doctor’s delay in performing a C-section. Due to this injury, the boy contracted a condition known as hypoxic ischemic encephalopathy or HIE in short, which is also called perinatal encephalopathy. This is a result of the brain not being able to receive enough oxygen, known medically as hypoxia. HIE refers to all brain injuries that are caused by oxygen deprivation or hypoxia, but is only referred to injuries that are common amongst newborns which can cause long-term to permanent disability and, in worst cases, death.
HIE in newborns are most usually caused by injuries or complications in time of birth where the fetus suffers from hypoxia. Some known causes of HIE include:
- An injury during birth / labor process
- Perinatal asphyxia
- Complications faced due to late and / or delayed delivery
- Umbilical cord tied on the neck of the baby
- An injury done to the brain, or the head are, during birth / labor process
According to the latest data, in United States, Hypoxic Ischemic Encephalopathy is in at least one to eight out of 1,000 births. If the HIE is severe, the rate of mortality is set at 20%, resulting to the death of the baby during his or her first weeks of life. Survivors, however, are left developing permanent defects which may leave him or her impaired for the rest of his or her life. For infants that survive fatal HIE, 80% of them will develop complications on their life, while 10-20% will develop moderate complications, and the remaining 10% having no complications at all. For infants with moderately severe Hypoxic Ischemic Encephalopathy, 30-50% will have serious diseases during their growing-up years, while 10-20% will have minor complications.
Hypoxia and HIE does not occur on the whole brain area, but rather, on only one part of brain. Hypoxic Ischemic Encephalopathy subsequently leads to brain injury as a result of hypoxia and less blood flow. In order to function properly, brain cells must receive a constant supply of oxygen-rich blood. Should it fail to receive oxygen and oxygen-rich blood, it will not function properly and may die. For an infant, 5 minutes of oxygen deprivation is a matter of life and death, as this may result in irreversible brain damage or cerebral palsy.
The damage done to the brain largely depends on the time the brain functions without enough oxygen. A few seconds of oxygen deprivation may only result to neglegible brain cell injury while few minutes of oxygen deprivation can cause massive and irreparable damage to the brain, including hippocampus, which is a vital part of the brain.
Regardless of how long or how short the brain functions without a steady supply of oxygen, the victim might suffer from a whole slew of diseases, such as long-term or permanent disability, epilepsy, seizures, mental retardation, delayed growth development, learning disability and cerebral palsy.
To properly diagnose HIE, physical exams, accompanying other tests like MRI scan, CT scan, electrocardiogram (ECG / EKG), electroencephalogram (EEG), blood test, or ultrasound are needed. Treating HIE involves resuscitation (if patient faints), mechanical ventilation to ensure and help with proper breathing.
For further information on oxygen deprivation at birth: