Health

What is HIE? The condition affecting newborns has led to reviews in Portiuncula hospital

Many factors raise risk of hypoxic-ischemic encephalopathy, caused by lack of oxygen to the brain

Hypoxic-ischemic encephalopathy is an umbrella term for a brain injury that happens before, during, or shortly after birth when oxygen or blood flow to the brain is reduced or stopped. Photograph: Alamy
Hypoxic-ischemic encephalopathy is an umbrella term for a brain injury that happens before, during, or shortly after birth when oxygen or blood flow to the brain is reduced or stopped. Photograph: Alamy
Muiris Houston
Tue Jan 28 2025 - 16:40

The appointment of an external management team to oversee and manage maternity services at Portiuncula University Hospital (PUH) in Co Galway is a sign there are serious concerns at the hospital. It follows an unusually high rate of babies diagnosed with neonatal hypoxic-ischemic encephalopathy (HIE) there. During 2024 and 2025 six of seven babies with HIE required referral for neonatal hypothermic treatment, also known as neonatal cooling.

“We are making these changes now to ensure the maternity service at Portiuncula is as safe as possible for mothers and their babies,” said Dr Pat Nash, regional clinical director of HSE West and North West about the externally led review.

A previous 2018 report found several failings in relation to the Galway hospital’s maternity care services. Among the shortcomings were a lack of consultants at weekends, insufficient training among locum doctors, a lack of communication between healthcare professionals and an absence of open disclosure with patients and their families.

What is Hypoxic Ischaemic Encephalopathy?

Hypoxic-ischemic encephalopathy is an umbrella term for a brain injury that happens before, during, or shortly after birth when oxygen or blood flow to the brain is reduced or stopped. It is usually diagnosed shortly after a child’s birth and the symptoms can range from mild to severe. They may include seizures or the infant may have trouble breathing, eating and hearing. Affected children may go on to experience developmental delay and learning difficulties.

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Individuals with HIE may also have heart, lung, kidney, or liver problems related to the lack of oxygen they experienced.

Which babies are at risk of developing HIE?

A wide range of factors can raise a baby’s risk for HIE. They include:

  • Very low or high blood pressure in the mother;
  • Heart problems in the baby;
  • Problems with the uterus or placenta (afterbirth);
  • Extremely premature birth;
  • Problems during labour and delivery that restrict blood flow to the infant;
  • Poor oxygen supply to the baby during pregnancy;
  • Physical trauma to the baby’s brain or skull.

What are the symptoms Of HIE?

The symptoms of neonatal HIE can vary from baby to baby. They depend on which part of an infant’s brain is damaged and symptoms can range from mild to severe. They may include:

  • Slow heart rate;
  • Trouble breathing;
  • Seizures or unusual movements;
  • Low muscle tone;
  • Not eating.

How is HIE treated?

The main treatment for neonatal hypoxic-ischemic encephalopathy is therapeutic hypothermia. It lowers a child’s body temperature to help reduce the risk of neurological problems. Treatment depends on a baby’s symptoms, age, and general health. Therapeutic hypothermia is used for moderate to severe neonatal hypoxic-ischemic encephalopathy.

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It must be given within the first six hours after birth. During it, a cooling system lowers the child’s body temperature to 33-34 degrees for up to 72 hours. Doing so may improve the chances of a child’s survival. It may also lower the risk for developmental problems or disability later in life. HIE babies will also require supportive care. An infant may need oxygen or a ventilator to breathe and medicines may also be given to treat seizures and other health problems.

How common is neonatal encephalopathy and what is the outcome for affected children?

Some 72 infants in Ireland with hypoxic-ischemic encephalopathy required therapeutic hypothermia in 2019. The incidence of therapeutic hypothermia was 1.2 per 1,000 births for the year. The total mortality rate for infants in the therapeutic hypothermia cohort for the period 2016-2020 was 14 per cent. The incidence of long-term complications depends on the severity of HIE. As many as 80 per cent of infants who survive severe hypoxic-ischemic encephalopathy develop serious complications. Among the babies who survive moderately severe HIE, some 30-50 per cent may have serious long-term complications such as cerebral palsy, epilepsy or a learning disability.