Hypoxic-Ischemic Encephalopathy in the Neonate

Hypoxic-ischemic encephalopathy, or EHI, is brain damage caused by a lack of oxygen to the brain, also commonly known as asphyxia during childbirth.

The body of the newborn can compensate for brief periods with depleted oxygen, but if suffocation lasts too long, the brain tissue is destroyed.

Hypoxic-ischemic encephalopathy due to fetal or neonatal asphyxia is a leading cause of death or serious deterioration in infants.

Said alteration may include epilepsy, developmental delay, motor alterations, retardation of neurological development, and cognitive deterioration.

In general, the severity of the disturbance can not be determined until the child is three to four years old.

For a long time it was thought that suffocation was the cause of cerebral palsy, but two studies have shown that only 9% of cases are the direct result of asphyxia.

In the remaining 91% of cases, factors such as premature birth, complications of birth or problems immediately after birth cause cerebral palsy. In some cases, the cause can not be definitively determined.

When is hypoxic-ischemic encephalopathy?

It is more common in term babies, although it occurs in premature babies, too. The timing and severity of asphyxia can affect the area of ​​the brain that supports the injury.

If the lesion occurs before week 35 in fetal development, hypoxic-ischemic encephalopathy is likely to produce periventricular leukomalacia.

At 40 weeks, the degree of hypoxia correlates with the area of ​​the brain that is injured; mild hypoxia affects the parasagittal white matter, while severe hypoxia affects the putamen, thalamus and paracentral white matter.

The area of ​​the brain that is affected will have a significant influence on the symptoms that the child experiences.

What are the risk factors and causes of EHI?

Choking is the most important risk factor for HIE. The severity and duration of oxygen deprivation will depend on how severe the hypoxic-ischemic encephalopathy is.

Events that lead to suffocation include:

  • Acute maternal hypotension.
  • The blood contains less oxygen due to malfunction of the lungs.
  • Cardiac complications
  • Lesions due to cephalo-pelvic disproportion.
  • Injuries caused by complications of the umbilical cord.
  • Altered blood flow to the brain during delivery.
  • Interruptions of breathing or lack of oxygen supply.
  • Hemorrhage during childbirth.
  • Medical negligence.
  • Prolapse of the umbilical cord.
  • Detachment of the placenta.
  • The pressure in the skull that can change the shape, resulting in bleeding or decreased blood flow.
  • Rupture of vasa previa.
  • The stress of childbirth and childbirth
  • Trauma.
  • Uterine rupture.
  • Fetal stroke also increases the likelihood of hypoxic-ischemic encephalopathy.

Factors that can cause a fetal stroke include:

  • Abnormalities of blood coagulation.
  • Blockage of blood flow in the placenta.
  • Malformed or weak blood vessels, which can break.
  • Maternal blood pressure high or low.
  • Maternal infection, especially pelvic inflammatory disease.


Once hypoxic-ischemic encephalopathy is suspected, neuroimaging techniques, especially magnetic resonance imaging, are performed to aid diagnosis.

It is believed that new techniques, including weighted diffusion imaging and MR spectroscopy, can be effective when used within the appropriate time frame.

To carry out these tests, doctors must first suspect hypoxic-ischemic encephalopathy. If the delivery was traumatic, or if there is an important risk factor during pregnancy as a stroke, hypoxic-ischemic encephalopathy can be suspected at birth.

Otherwise, parents and doctors should take note of visible signs, motor disease, delayed development, and growth retardation through clinical observation.

A level of severity status is provided when cognitive development can be assessed accurately.

Certain signs may appear shortly after birth. Organ dysfunction, especially of the heart, lungs, kidneys, liver and blood, indicates a possible EHI.

Seizures in the first 24 hours of life may also indicate the possibility of hypoxic-ischemic encephalopathy.

There are three levels of hypoxic-ischemic encephalopathy: mild, moderate and severe.

Care must be taken to rule out several neurodegenerative and metabolic conditions that slowly slow down progress and synoptic cerebral palsy.


The treatment focuses on helping the child adapt to the symptoms that result from the brain injury. Physical and occupational therapies are commonly used to treat cerebral palsy caused by hypoxic-ischemic encephalopathy.

Asphyxia usually causes permanent damage, which sometimes continues to progress even after suffocation has been relieved. To prevent further harm, the child must be medically supervised to:

  • Keep blood glucose normal.
  • Maintain normal blood pressure.
  • Prevent or treat seizures.
  • Prevent or minimize cerebral edema.

How can you foresee?

The best way to prevent hypoxic-ischemic encephalopathy is to eliminate asphyxia during pregnancy and childbirth.

Knowledge of risk factors can help parents and medical staff prevent and prepare for possible complications.