Hypoxic ischemic encephalopathy (HIE) is a condition in which a newborn’s brain does not get enough oxygen.

HIE can be fatal. Brain cells can start to die after 4 minutes without oxygen.

The Brain

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There are many causes of HIE that may occur before or during labor and delivery. Any injury and many health conditions can also cause a lack of oxygen to the brain.

  • Some common causes in the mother include:
    • Ruptured uterus (womb)
    • Cardiovascular collapse with respiratory failure
    • Preeclampsia—high blood pressure and organ damage
    • Seizures
    • Trauma
    • Carbon monoxide poisoning
  • Some common causes in the newborn include:
    • Separation of the placenta (an organ that nourishes the baby) from the uterus
    • Cord prolapse—when the umbilical cord exits the uterus with or before the fetus
    • Shoulder dystocia—when the infant’s shoulders get stuck in the mother’s body
    • Exposure to extreme heat

Risk Factors

Having any of the above causes may raise your infant’s risk of HIE.


Symptoms in your infant may be mild to severe. They may include:

  • Amniotic fluid that is stained with meconium, which is the first stool of your infant
  • Signs of brain injury, such as
    • Muscle tone that seems loose or floppy
    • Reduced alertness
    • Seizures
  • Trouble breathing
  • Blue colored skin or lips

Symptoms may also involve other organs, such as the liver, kidneys, or the heart.


You will be asked about your infant’s symptoms and medical history. A physical exam will be done.

Your infant’s blood may be tested.

Images may be taken of your infant’s bodily structures. This can be done with:

  • MRI scan
  • MRA scan

The activity of your infant’s brain may be tested. This can be done with an EEG.


Talk with the doctor about the best treatment plan for your infant. Treatment depends on the underlying cause of the condition and the amount of damage to the brain. Options include:

  • Treatments for the circulatory system—Treatments are given to maintain heart function, control blood pressure, and restore blood flow.
  • Mechanical ventilation—This may be used if your infant can’t breathe without help.
  • Seizure control—Medication and general anesthesia may be given to control seizures.
  • Cooling—Hypoxic brain damage is often caused by heat. Cooling blankets or other means of cooling may be used to lower your infant’s temperature.


In most cases, HIE is sudden and cannot be prevented.