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Child with HIE

The 3 Stages of Severity in Babies with HIE

Hypoxic-ischemic encephalopathy (HIE), also called perinatal asphyxia, describes when a lack of blood flow starves the brain of oxygen, which can result in a brain injury. These types of injuries can occur during pregnancy and childbirth, and they can range from very mild and temporary to severe or even deadly, depending on how long the baby is deprived of oxygen.  

Let’s break down the technical medical terms found in hypoxic-ischemic encephalopathy 

  • Hypoxic: This describes when the body or part of the body is not getting enough oxygen  
  • Ischemic: This describes when the body or part of the body is not getting enough circulation or blood flow (blood flow supplies oxygen)  
  • Encephalopathy: This is damage or disease to the brain. 

When the brain does not get oxygen or enough oxygen, there can be lasting damage, depending on how long it was starved of oxygen. The severity of HIE can be broken into three stages: 

Stage 1 (Mild hypoxic-ischemic encephalopathy). This includes behavioral issues, which might be hard to differentiate from normal issues, such as poor sleep and feeding, as well as irritability and crying. These cases typically resolves in 24 hours. 

Stage 2 (Moderately severe hypoxic-ischemic encephalopathy). In these cases, the baby is lethargic (i.e., tired and sluggish), with significant muscle limpness and poor reflexes, including little or no grasping and sucking reflexes. There may be periods of apnea (brief pauses in breathing). If there are seizures, they occur within the first 24 hours. These cases can have full recovery within a couple of weeks.  

Stage 3 (Severe hypoxic-ischemic encephalopathy). The symptoms are far more severe, including:  

  • Delayed seizures (24-48 hours after onset)   
  • Stupor or coma 
  • Irregular breathing 
  • Muscle weakness 
  • Absence of neonatal reflexes (ege.g., sucking, swallowing, grasping, Moro) t 
  • Unusual eye motion or dilation 
  • Problems with heart rate and blood pressure 

The prognosis for Stage 3 HIE can be increased deterioration, injury, and even death.  

The health issues will vary depending on the child and the severity of the HIE. There can be a total recovery, while others might have a permanent disability, such as developmental delay, cerebral palsy, epilepsy, or cognitive impairment. 

