Hypoxic-ischemic encephalopathy is a complex condition. No two cases are the same. In fact, a diagnosis of HIE can mean anything from the baby having mild issues to the worst-case scenario that the situation is fatal. This is why hypoxic-ischemic encephalopathy stages are an important classification tool for doctors. 

In this article, we’ll examine:

• What HIE is
• What the 3 HIE stages entail
• How HIE may progress
• Treatment methods for HIE

So continue reading to learn more valuable information.

What is Hypoxic-ischemic Encephalopathy?

Hypoxic-ischemic encephalopathy, or HIE, is a type of Brain injury. It occurs when an infant’s brain doesn’t receive enough oxygen and blood flow during or near the time of birth.

HIE is a medical emergency that requires immediate medical attention and intervention. The severity of HIE can have long-term effects on a baby’s development.

Treatment for HIE may include therapeutic hypothermia (cooling therapy) to reduce brain damage and supportive care in a neonatal intensive care unit (NICU). Later in life, children with HIE may require medication, physical therapy, behavioral therapy, and other types of therapy.

HIE Stages Explained

Doctors classify HIE into stages based on severity. They diagnose a baby with either Stage 1, Stage 2, or Stage 3 HIE after performing evaluations and tests. 

The most commonly used staging system is the Sarnat and Sarnat classification. It includes three stages:

Mild HIE: Stage 1

• The infant may appear slightly lethargic and have some mild muscle tone changes.
• Reflexes may be slightly depressed or normal.
• The baby’s heart rate and breathing may be irregular.
• Seizures may or may not be present.

Moderate HIE: Stage 2

• The infant is usually more lethargic and has significant muscle tone abnormalities, such as “floppiness” or “stiffness.”
• Reflexes are often abnormal or weak.
• Breathing difficulties may be more pronounced.
• Seizures are likely to be present.

Severe HIE: Stage 3

• The baby is usually unconscious and may not respond to stimuli.
• Muscle tone is severely affected, leading to “stiff” or “ragdoll” posture.
• Reflexes are absent or minimal.
• Breathing may be shallow or labored.
• Seizures are common and may be difficult to control.

Why are some Hie Stages more mild than others? The severity of a child’s HIE depends on these factors:

• How restricted the blood flow to the brain was
• Whether the baby was getting some oxygen or none at all
• How long the brain was starved of oxygen

How Does HIE Progress?

A baby might have a diagnosis of Stage 1 HIE at birth. But it’s possible for Stage 1 to progress to Stage 2. Stage 1 can also progress to stage 3. Or, a child can be diagnosed with Stage 2 or Stage 3 HIE from the start. 

Thankfully, most cases of mild HIE (Stage 1) don’t progress any further. Babies with mild HIE can even make full recoveries. 

Babies with HIE stages 2 or 3 are the ones that may “take a turn for the worse”. This is because their initial oxygen deprivation was more severe. It causes a series of predictable events, much like dominoes set up in a line. 

Medical professionals have organized these events into phases. It’s a lot to get into here, but we’ll give you an overview of what each phase entails.

Concerning Phases

1. Oxygen Deprivation. The brain is deprived of sufficient oxygen and blood flow. This can happen during labor and delivery due to various factors. These include placental insufficiency, umbilical cord problems, or maternal health issues.
2. Primary Energy Failure. The brain lacks adenosine triphosphate (ATP), its source of energy. The body starts producing too much lactic acid in an attempt to “keep the power on” in the brain. This leads to brain swelling, and calcium builds up in brain cells. 
3. Cellular and Tissue Damage. Chemical reactions in the brain lead to cell damage and death. With HIE stages 2 and 3, the baby’s organs suffer damage as well. 
4. Latent Period. This is a period of recovery for babies with HIE stages 2 and 3. It’s the phase when blood flow to the brain is normal again. The brain is getting oxygen, but previous damage can’t be undone. 
5. Secondary Energy Failure. Anywhere from a few hours to a couple of days later, a baby with Stage 2 or 3 HIE can suffer another round of brain damage. Why does this happen? The body starts sending too much blood to the brain. The reason for this overcompensation can be because the body made too many new blood vessels after the brain was injured. Or, free radicals (unstable molecules) may be to blame. 
6. Tertiary Phase. In the weeks and months after the injury, the brain tries to rebuild and adapt. Some infants may show improvements in their condition. Others may experience additional challenges as the brain begins to heal itself.

Can Doctors Prevent a Baby from Progressing Through HIE Stages?

As you might imagine, intervention from the start is critical. As soon as doctors see signs of HIE, they should provide treatment to prevent the baby’s condition from worsening. 

Swift treatment can help keep more damage from happening. It can help give the baby a fighting chance. But it’s no guarantee that a baby won’t progress to further HIE stages. This can still happen because of the internal chain reactions we discussed above. 

With initial HIE treatment, the focus is on restoring oxygen and blood flow to the brain and preventing further brain damage.

Treatment for Hypoxic-ischemic Encephalopathy

With initial HIE treatment, the focus is on restoring oxygen and blood flow to the brain and preventing further brain damage.

Here’s what doctors can do to help a baby’s brain heal:

Therapeutic Hypothermia (Cooling Therapy)

• Doctors carefully and slowly lower the baby’s body temperature to around 33.5°C to 34.5°C (92.3°F to 94.1°F) for a duration of 72 hours.
• This cooling process helps slow down the brain’s metabolism. It reduces the harmful effects of the lack of oxygen and blood flow.
• Cooling therapy must happen within the first six hours after birth for it to work. In some cases, it can still be beneficial up to 12 hours after birth.

Monitoring and Supportive Care:

• The baby stays in the neonatal intensive care unit (NICU). Doctors monitor vital signs, brain activity, and other essential parameters.
• They provide supportive care to maintain stable breathing, heart rate, and blood pressure.

Seizure Management

• Babies with HIE (especially HIE stages 2 and 3) often have seizures. 
• Doctors may prescribe anticonvulsant medications to control and prevent seizures.

Correction of Underlying Issues

• Sometimes, specific conditions like umbilical cord problems or maternal health issues lead to HIE. 
• Doctors need to treat these underlying health issues to improve outcomes for the baby. 

Can Negligence Cause HIE?

Some cases of HIE are preventable (including moderate to severe HIE stages). We all wish doctors were perfect and incapable of making mistakes. But that’s not reality–doctors do make errors on occasion. They’re “only human”, after all. 

But when those errors are so grave that they cause injuries like HIE, being “human” isn’t an excuse. You may be able to hold a doctor accountable for HIE-related negligence when they:

• Fail to diagnose or treat HIE
• Delay a diagnosis of HIE
• Delay treatment for HIE
• Do not perform a Cesarean when it’s necessary
• Fail to treat an underlying condition, which leads to HIE

Hampton & King is a national leader in birth injury law. We help families recover damages that help them cover lifetime treatment costs for their children. In one case of HIE-related malpractice, we recovered $6,500,000 for negligent fetal heart rate monitoring. 

Ready to discuss your case with expert lawyers who care? Contact us here. 

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