Hypoxic Brain Injury: Causes, Treatment and Support

What Is a Hypoxic Brain Injury?

A hypoxic brain injury is what happens when there is not enough oxygen supplied to the brain to the extent that this causes cerebral or neurological damage.

Where hypoxic brain injury does occur, it could be hypoxic or hypoxic-ischaemic. While hypoxic refers to there not being enough oxygen, ischaemic means not enough blood flow, so a hypoxic ischaemic brain injury means a shortage or absence of both.

Somebody can experience hypoxia without it causing any lasting disturbance to the brain.

Hypoxic episodes happen mostly around birth, including the prenatal, perinatal and neonatal stages. However, for older children and adults, they can take place in other ways that are disconnected from birth.

What Causes a Hypoxic Brain Injury Around Birth?

Hypoxic brain injury around birth (an acquired brain injury) can be brought on by many different events. One of these is during delivery, when the umbilical cord gets trapped between the bone of the baby’s head and the bone of the mother’s pelvis.

A hypoxic brain injury can also arise from unnoticed problems leading up to birth, including placental dysfunction, pre-eclampsia and maternal infection. In some cases, a failure to recognise or respond appropriately to these risks may indicate a breach of duty by the professionals responsible for care.

This pattern was noticed in The Ockenden Review, an overview of maternity care at Nottingham University Hospitals NHS Trust. Read more about the incidents of birth and brain injury that occurred here.

There are two main types of hypoxic events:

Acute Profound Hypoxic Ischaemia

Acute profound hypoxic ischaemia is a sudden, near-total interruption of oxygenated blood at the crucial delivery or perinatal stage. ‘Profound’ refers to there being zero or very little oxygen, while ‘acute’ refers to the sudden nature of the injury.

The duration of this kind of hypoxic episode is crucial when it comes to survival. There is medical debate around the timings, but 25 minutes is generally considered a very dangerous marker for babies. In other words, every minute counts.

Chronic Partial Hypoxia

Chronic partial hypoxia refers to a longer period of reduced oxygen. It can be more difficult to establish the timing and the extent of the injury compared to an acute profound ischaemic injury, as the effects are less visibly pronounced.

Hypoxic Brain Injury Symptoms

Sometimes a hypoxic brain injury is missed by professionals, causing symptoms to manifest later that you might not be able to explain. These can include neurological, physical and behavioural changes such as:

Memory loss

Speech and language difficulties

Emotional difficulties

Emotional changes

Executive dysfunction

Loss of motor function
Sensory or visual changes

Speaking to a medical professional can help to assess these symptoms and illuminate the possible cause(s), before you consider what to do next.

Hypoxic Ischaemic Brain Injury and HIE

If a hypoxic ischaemic episode (reduced blood and oxygen flow) reaches a certain degree of severity and elapses for a long enough time, it could potentially lead to hypoxic ischaemic encephalopathy (HIE), which does pose a risk of mortality in some cases.

‘Encephalopathy’ means there is an effect on/injury to the brain. HIE can lead to a range of short- and long-term effects, depending on the location and extent of the neurological injury – plus the time of intervention. It can be clinically classified using the Sarnat grading scale as mild (stage 1), moderate (stage 2) or severe (stage 3).

Some potential long-term outcomes of HIE include:

Cerebral palsy
Epilepsy/seizures

Intellectual and developmental disability

Hearing loss

Vision impairment

Feeding and speech difficulties

Behavioural and attention differences

The key to managing these long-term effects is intervention. Suitable prenatal, perinatal and neonatal care are all integral to minimising the risk of hypoxia in the first place.

If hypoxia results in brain injury, there is still opportunity and hope for midwives and/or obstetricians to appropriately monitor and manage the effects of the injury.

How Is Hypoxic Brain Injury Diagnosed?

Because hypoxic brain injury can emerge in many ways, there are also many ways for it to be diagnosed. This can include:

Diagnosis method	How it works
Paediatric neurology exams	These exams are used to evaluate a child’s nervous system through observational, developmental assessment, motor testing and more. This can reveal any neurological issues that could link back to hypoxia.
Neonatal encephalopathy	Hypoxia and seizures are commonly linked as seizures can be caused by brain irritation, which stems from neonatal encephalopathy. This can be assessed through cerebral function monitoring, which looks for signs of seizure activity using tools like an EEG.
Umbilical cord blood gases	These gases should be taken from the vein and artery. They can be used to reveal acidosis, where the cord pH is too low because of tissues not receiving enough oxygen.
Imaging	An MRI scan can be a very useful tool for detecting the structural damage of a hypoxic brain injury. However, a normal MRI scan does not always rule out a hypoxic brain injury as MRIs do not always pick up functional damage.

Hypoxic Brain Injury in Adults and Older Children

Outside of birth, cerebral hypoxia could arise in a variety of ways, which can subsequently cause a hypoxic brain injury. Although these are less common than cases that might take place around birth, they do still occur. This can include:

Cardiac or respiratory arrest

Irregular heart rhythm after a heart attack

Disturbed heart function

Strangulation or suffocation

Very severe asthma attack

Very severe allergic reaction

Near-drowning

Exposure to high altitudes

Smoke or carbon monoxide inhalation

Poisoning

Drug overdose

No matter what stage hypoxic brain injury occurs at, it can be life-changing. Read about Maciej’s hypoxic brain injury story to discover his experience, the obstacles he faced and how support from others helped him to build up determination and confidence.

How Is Hypoxic Brain Injury Treated?

Treatment methods for hypoxic brain injury are tailored to the severity and the stage at which the injury develops. For instance, babies who are affected leading up to or around birth may be treated with therapeutic cooling. Therapeutic cooling may also be called by other names, such as cooling therapy or neonatal cooling.

The method involves cooling the baby down to a temperature below homeostasis to allow the brain to recover from a hypoxic-ischaemic injury.

Therapeutic cooling, while very effective when done correctly, does not heal the injury itself. Like any other methods of treatment, it focuses on managing symptoms and minimising the risk of secondary injury and further complications rather than healing the brain.

The most immediate treatment for hypoxic brain injury is resuscitation to restore oxygen to the brain, which will be administered in more extreme or acute cases. More gradual approaches to managing effects include oxygen therapy, hemodynamic support and, holistically speaking, rehabilitation.

Rehabilitation for Hypoxic Brain Injury

Like any other acquired brain injury, the main goal for rehabilitation is to offer support from a range of specialists, encouraging you to achieve the best possible outcome and quality of life.

Everyone’s experience of rehabilitation is different due to the varying nature of hypoxic brain injury. It could involve anybody from physiotherapists and occupational therapists to specialist nurses and speech and language experts. In all cases, rehabilitation is most beneficial at the earliest possible stage of injury.

For babies and young children, neuroplasticity means that the brain is still adapting and developing, establishing new ‘roads’ or neural pathways with every new experience and learning. Therefore, addressing neurological obstacles early through services like neurotherapy and neuropsychology can encourage the best course of neurodevelopment.

Hypoxic Brain Injury Birth Claims

If a hypoxic brain injury at birth is caused or worsened by somebody else, you may be able to get legal support through pursuing a medical negligence claim. While receiving compensation does not reverse resulting stress or damage, it can lessen financial stress for you and any family members.

A specialised hypoxic brain injury solicitor will instruct relevant clinical experts to gather any medical information that will help with the hypoxic brain injury claim. This includes when and how the injury occurred, if the care fell below the appropriate standard and whether that made what’s called a material difference.

Some questions medical professionals may ask to inform their evidence include:

Were there problems with the fetal heart before delivery?
Was there adequate monitoring?
Were abnormalities picked up/escalated in a timely manner?
Was the CTG interpreted correctly?
Was a caesarean section necessary, and if so, was it requested or refused?

The question at the heart of any hypoxic brain injury compensation claim is whether timely and appropriate care could have shortened the period of hypoxia.

Other Types of Support

At Brain Injury Group, we have our own network of brain injury specialists in different areas, from rehabilitation to wellbeing and legal experts with a brain specialism. Our role is to offer advice, guidance and signpost you to professionals who will endeavour to support you throughout your injury.

If you are suffering with hypoxic brain injury – or suspect you or a loved one may be presenting symptoms – it is important that you contact a healthcare professional to assess the situation. Once you have done this, we can guide you through any potential avenues for support and help you to figure out the best next steps.