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Cooling Therapy - More About HIE

Newborns that experience oxygen deprivation before, during, or immediately after birth suffer from hypoxic ischemic encephalopathy, HIE. HIE is an abnormal neurological state that impacts the baby’s brain and body.

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HIE can be caused by a medical complication or as a result of an injury at birth. The symptoms may be categorized as mild, moderate or severe. In the case of severe or lengthy loss of oxygen, the infant could be in extreme distress and may not survive.

Cooling therapy for newborns with HIE is a relatively new treatment. Until cooling treatment was used the only treatments available were meant to manage the symptoms. Cooling treatment is actually able to reduce or prevent some additional injury from occurring after an infant has suffered from oxygen deprivation.

Symptoms of HIE

Elk & Elk

An infant may exhibit some of the signs of hypoxic ischemic encephalopathy immediately following birth. The most common symptoms of HIE include:

  • Need for Resuscitation
  • Low Apgar Score
  • Seizures
  • Problems with Feeding
  • Low Muscle Tone
  • Organ Problems
  • Abnormal Brain Stem Reflexes
  • Coma

Symptoms may range from mild to severe. Even mild symptoms show a need for further testing and evaluation. This must be done as quickly as possible after birth so that if therapeutic hypothermia treatment is needed it can be provided.


Hypoxic ischemic encephalopathy needs to be identified as quickly as possible after birth. If oxygen deprivation is suspected, the doctor will begin testing immediately. Some of the HIE tests that may be done include CT scans, MRI, PET scan, EEG, blood glucose test, arterial blood gas tests, and ultrasound. These will help indicate whether damage has occurred and if so, how it is impacting the child’s health. Additionally, the doctor will perform a neurological exam to visually diagnose an infant’s condition.

Causes of HIE

Generally, the longer an infant is without oxygen the more severe the damage is. There are a number of reasons why an infant may have experienced oxygen deprivation. A ruptured uterus, placental bleeding and shock or seizures of the mother could cause poor blood or oxygen flow to the infant before birth. During labor and delivery the infant could have an umbilical cord injury or the birth may be prolonged and difficult. If labor becomes stalled, if the infant becomes stuck in the birth canal, or the baby is positioned incorrectly, the doctor needs to act quickly to resolve the problem and assist with the birth. If an ultrasound or other testing before labor indicates a high-risk, special accommodations must be made.

Who Should Be Treated with Whole Body Cooling

Infants who have suffered a lack of oxygen at any time during labor or delivery may be candidates for cooling therapy. A newborn who is diagnosed with HIE is a candidate for whole body or head cooling, which may help reduce or prevent further brain damage from occurring over the next three days, the most critical period of time for newborns.

Some infants with HIE are not eligible to receive cooling treatment. Those who are critically ill or have unstable vital signs should not receive treatment. Also, children who are premature and weigh less than 1800 grams should not get neonatal cooling. Infants who suffer from chromosomal abnormalities are not eligible for this treatment. Additionally, neonatal cooling must be started within the first 6 hours after birth. Infants older than 6 hours are not typically provided cooling therapy.