One page summary: Hypoxic-ischemic encephalopathy (HIE) in newborns

In two sentences

Hypoxic-ischemic encephalopathy, or HIE, is brain injury caused by low oxygen and low blood flow around the time of birth. "Hypoxic" means low oxygen, "ischemic" means low blood flow, and "encephalopathy" means the brain is not working normally.

If your baby is in the first six hours of life and the team is talking about HIE, the most time-sensitive question is whether they will start cooling. Cooling is not the right word to search: the treatment is called therapeutic hypothermia, and starting it within six hours of birth lowers the chance of death or major disability. ¹

The numbers, with their sources

• How often it happens. About 1.5 babies in every 1,000 born alive in high-income countries develop hypoxic-ischemic encephalopathy ²
• The treatment window. Therapeutic hypothermia is started within six hours of birth. That window is why the NICU moves so fast on the first day ¹
• How much cooling helps. In a review of 11 trials with 1,505 babies, cooling reduced death or major disability. About seven babies need to be cooled for one extra baby to survive without major disability ¹
• How it is staged. Doctors use Sarnat staging: stage 1 mild, stage 2 moderate, stage 3 severe. The stage is set by examining the baby, not by a scan ³
• What professional bodies say about cause. No single test proves that events during labor caused a newborn brain injury. Cause is worked out from a pattern of findings taken together ⁴

What to do this week

1. Ask what the MRI showed and when it was done. Ask for a copy of the radiology report, not a summary of it.
2. Ask which Sarnat stage was recorded, and at what time. Ask whether cooling was considered, and what the reason was for the decision either way.
3. Request the complete records for you and your baby. Do it now, while the hospital's own copies are fresh and complete. The records request builder writes both letters for you, with your state's fee limit and deadline.
4. Write down what you remember about the labor, hour by hour. Memory fades faster than you expect. The delivery timeline builder prompts you for the details that turn out to matter.
5. Refer your child to early intervention. You can do this yourself today, before any diagnosis is confirmed. Use the early intervention finder.
6. Ask whether the placenta was sent to pathology, and request that report separately. It is often filed apart from the rest of the chart.
7. Start a binder. The NICU binder pack prints out with tabs and daily log sheets.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the neonatologist

• Which Sarnat stage was my baby, and at what time was that recorded?
• Was therapeutic hypothermia considered? What was the decision, and why?
• What were the cord blood gas results, including pH and base deficit?
• What did the MRI show, and which areas of the brain are involved?
• Was an EEG done, and did it show seizures that we could not see?
• Was the placenta sent to pathology? Can I have that report?
• What are you watching for in the next 48 hours?

For the pediatric neurologist

• Based on the MRI, which functions are most likely to be affected?
• What would you expect to see by 6 months if things are going well? What would concern you?
• Does my child need seizure medicine at home, and for how long?
• How often should we come back, and what will you check each time?
• Which parts of the outlook are genuinely uncertain right now?

For the developmental pediatrician or the therapy team

• Which therapies do you recommend, how often, and what is the goal of each?
• What should we practice at home between sessions?
• How will we know whether therapy is working?
• When should we look at equipment, and who prescribes it?
• Who coordinates all of this, and how do I reach that person?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Hypoxic-ischemic encephalopathy (HIE) in newborns

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.