TRIGGER WARNING: NEWBORN ILLNESS, BRAIN INJURY DISCUSSED, INFANT DEATH MENTIONED.

Hypoxic Ischemic Encephalopathy (HIE) is a rare, but devastating birth outcome. I have been asked several times to cover it as a topic, but if you feel it will be triggering, you may not wish to read it.

‘Hypoxia’ = lack of oxygen. ‘Ischemia’ = lack of blood supply. And ‘encephalopathy’ is a state of brain irritation brought on by swelling of the injured brain. So HIE is caused by lack of oxygen and lack of blood supply to the brain, usually either just before, during or after delivery.

There are several possible causes for HIE, including shoulder dystocia, placental abruption, uterine abruption, umbilical cord prolapse. I am not an obstetrician, so I cannot write about how these conditions affect the pregnant woman. I can tell you a bit about how we paediatricians and NICU nurses look after the baby once it is apparent that they are at risk of HIE.

Sometimes the baby has signs of distress before birth. The paediatric team is called and is on hand to check out the baby, and provide the necessary medical support once born. A breathing tube may be placed and medications given. The baby will be taken to the NICU. Unfortunately, in emergencies, the parents may not get to meet baby right away.

Sometimes a baby comes out unexpectedly unwell, with low muscle tone, a poor breathing effort or a low heart rate. This will precipitate a ‘crash call’. The midwife at the delivery is trained in the initial stages of newborn resuscitation and will start working on baby before the team arrives.

There are very few moments more upsetting than the silence where a baby’s first cry should be. I simply cannot imagine what it must be like for parents.

The slides above go through the prognosis and treatment for babies with HIE.Cooling has had a positive impact on prognosis.

One lesson I have learned over the years is to be realistic with parents in this situation,but not to take away hope. It is my great honour to work with babies who have survived HIE. They, and their parents, are my best teachers.

Support for families at Irish Neonatal Health Alliance, Bliss.org.uk, and Hope for HIE Foundation.