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Lahey Health is now part of Beth Israel Lahey Health

by EBSCO Medical Review Board
(Cerebral Hypoxia; HIE)

Definition

Hypoxic ischemic encephalopathy (HIE) is a brain injury. It happens when the brain does not get enough oxygen.

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

Blood Supply to the Brain
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Causes

Many health problems can cause a lack of oxygen to the brain. Some common ones are:

  • Cardiac arrest
  • Blocked or ruptured blood vessel
  • A blocked airway due to:
    • Swelling, such as from an allergic reaction
    • Trauma
    • Drug use and drug overdose
    • Drowning
    • Choking
  • Carbon monoxide poisoning

Risk Factors

The risk of HIE is higher in people who have an injury or health problem that causes the brain to have a drop in blood flow and oxygen.

Symptoms

Problems may be mild to severe, such as:

  • Clumsiness
  • Problems with focus
  • Difficulty making decisions
  • Mood swings
  • Feeling very tired
  • Signs of seizures, such as confusion and muscle jerking
  • Loss of alertness
  • Blue-colored skin or lips
  • Problems breathing

Diagnosis

A physical exam will be done. A health history is the biggest factor in making the diagnosis.

Blood tests may be done.

Pictures may need to be taken of your body. This can be done with:

Your brain and spinal cord may be tested. This can be done with:

Your heart function may also be tested.

Treatment

Treatment depends on the cause of HIE. It also depends on how severe the damage is to the brain.

You may have:

  • Life-sustaining treatment—If brain function stops but damage is not great, then life-saving treatment is given. This may include CPR.
  • Cooling—Cooling blankets or other means of cooling may be used to lower the body's temperature.
  • Temperature control—Cooling and rewarming methods may be used.

Prevention

There are no known guidelines to prevent HIE.

RESOURCES

Brain Injury Association of America  http://www.biausa.org 

National Institute of Neurological Disorders and Stroke  https://www.ninds.nih.gov 

CANADIAN RESOURCES

Health Canada  https://www.canada.ca 

Ontario Brain Injury Association  http://www.obia.on.ca 

References

Busl KM, Greer DM. Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms. NeuroRehabilitation. 2010;26(1):5-13.

Hypoxic ischemic encephalopathy (HIE). Neurographics website. Available at: http://www.asnr.org/neurographics/2/1/1/4.shtml. Accessed October 1, 2020.

Hypoxic-ischemic encephalopathy in adults. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/hypoxic-ischemic-encephalopathy-in-adults . Accessed October 1, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 09/2020
  • Update Date: 05/21/2021