Treatment for neonatal and pediatric-acquired Hypoxic Ischemic Encephalopathy (HIE) starts as early as possible—sometimes within minutes of birth. The journey may begin in the NICU or PICU and continue through early intervention, therapies, and long-term supports. Understanding the range of treatments, from evidence-based interventions to emerging therapies, can help families make informed choices throughout the HIE journey to help children meet their unique individual potential.
Therapeutic hypothermia is a medical treatment used to protect the brain after an HIE event. It involves lowering the baby’s body temperature to about 33.5°C (92.3°F) for 72 hours to slow brain metabolism and reduce further injury to brain cells. This treatment must occur in a neonatal intensive care unit (NICU) with specialized equipment and trained staff.
Therapeutic hypothermia is currently the only proven neuroprotective treatment for moderate to severe HIE in newborns. ICooling is a resource-dependent intervention requiring specialized care, training and equipment combined with criteria to qualify for which babies it may help.
COOLING BLANKET (Whole Body Cooling)
Babies are placed on a blanket that is able to take the body temperature down as cool as 91℉/33℃.
COOLING CAP (Whole Body Cooling)
A cooling cap is placed on the babies' head taking the temperature down as cool as 91℉/33℃.
Timing Matters: Cooling must begin within six hours of birth to be effective.
Eligibility: Not all babies qualify—eligibility depends on the severity of symptoms, gestational age (≥35 weeks), and other clinical criteria. Cooling is also resource-dependent and often not available in lower resourced countries and regions.
Monitoring: Babies are closely monitored during and after cooling for brain activity, vital signs, and signs of complications.
Limitations: Cooling is not a cure. It can decrease inflammation that can lead to permanent brain injury. It has been shown to decrease death and disability for neonatal HIE. It has not been shown to be effective for pediatric-acquired HIE.
Side Effects: Cooling may have short term side effects like edema (swelling), blood pressure support needs, clotting issues, respiratory support needs, etc.
Therapeutic Hypothermia (Cooling) criteria can vary per hospital, region, and country. Primarily, babies must meet the criteria below:
Studies are ongoing to see if mild HIE babies can benefit from therapeutic hypothermia. Hope for HIE is a stakeholder partner in the COOL PRIME multicenter study for mild HIE and therapeutic hypothermia.
Research has shown that cooling can improve outcomes for some babies with moderate to severe HIE by slowing harmful processes in the brain, including inflammation and cell death. It doesn’t reverse damage already done, but it helps reduce the extent of injury.
Mild HIE was historically considered low-risk for long-term complications. However, recent studies suggest that some babies with mild HIE may still experience developmental, behavioral, or cognitive challenges later in childhood. Research is ongoing to better understand this group and whether cooling or other early interventions could help. Families of babies with mild HIE should receive neurodevelopmental follow-up to monitor milestones and support early intervention if needed.
Cooling is generally considered safe in NICUs with experienced teams. Potential side effects include:
Care teams closely monitor vital signs and lab values to minimize risks.
Therapeutic hypothermia requires specialized equipment, continuous monitoring, and a trained NICU team. Not all hospitals—especially smaller or rural facilities—are equipped for this level of neonatal intensive care. Instead, these hospitals often stabilize and transfer eligible babies to regional or academic centers that have cooling capabilities. Timely transport is a critical part of the system of care for babies with suspected HIE.
After cooling, babies are slowly rewarmed over 6–12 hours. This is done gradually to avoid sudden shifts in blood pressure and brain activity. Following rewarming, the care team often performs additional tests, including neuroimaging.
An MRI (magnetic resonance imaging) of the brain is often done within the first week or two of life to help visualize areas of injury. While not yet considered a standardized part of care everywhere, MRI is currently recommended as part of best-practice neuroimaging after HIE to:
MRI is a powerful tool but not predictive of every outcome. It’s one part of a larger clinical picture.
No. Cooling reduces the risk of death or severe disability, but it is not a cure. Outcomes can range from typical development to varying degrees of disability, depending on the severity of the injury and other factors.
In large clinical trials, cooling therapy reduced the combined rate of death or severe disability by about 40% in babies with moderate to severe HIE. It remains the only evidence-based treatment for HIE at this time.
Ongoing and follow-up neurodevelopmental care is essential. This may include:
Children who experience HIE benefit from ongoing evidence-based therapies and services, regardless of injury severity. Early intervention and access to developmental supports can significantly improve outcomes. Therapy services can be provided in government programs like Early Intervention, as well as outpatient therapy centers.
Physical Therapy (PT)
What it is:
Physical therapy focuses on improving movement, strength, coordination, and balance.
Why it's used for HIE:
Many children with HIE may experience motor delays or develop conditions like cerebral palsy -- up to 40% and across a wide spectrum of impacts, from very mild to very impacted. PT helps improve mobility, prevent joint stiffness, and encourages independence.
Evidence & Research:
Considerations for Families:
Resources:
Occupational Therapy (OT)
What it is:
OT helps children build skills for daily activities like dressing, grasping toys, or holding a spoon.
Why it's used for HIE:
OT addresses fine motor skills, sensory processing, self-care, and upper body coordination—areas often affected in children with neurological differences.
Evidence & Research:
Considerations for Families:
Resources:
Speech and Feeding Therapy
What it is:
Speech therapy helps with communication and language -- verbal or using Assistive and Augmentative Communication (AAC). Feeding therapy focuses on safe swallowing and eating skills.
Why it's used for HIE:
Children may have delayed speech, trouble swallowing, or feeding difficulties due to oral-motor challenges or neurological injury.
Evidence & Research:
Considerations for Families:
Resources:
Vision Therapy and Services
What it is:
Services focused on assessing and supporting visual development, including cortical visual impairment (CVI).
Why it's used for HIE:
HIE can affect the brain’s ability to interpret visual information, even if the eyes are healthy. Children with impacts to their vision from HIE can be brain-based and visual processing-related, or ocular-motor from cerebral palsy, or both.
Evidence & Research:
Considerations for Families:
Resources:
Hearing Services and Support
What it is:
Audiology services assess and support hearing, auditory processing, and communication development.
Why it's used for HIE:
While hearing loss isn’t always present, children with HIE may have auditory neuropathy spectrum disorder (ANSD) or brain-based auditory processing difficulties.
Evidence & Research:
Considerations for Families:
Resources:
Neurocognitive and Educational Services
What it is:
Supports that address thinking, learning, memory, executive function, and school readiness.
Why it's used for HIE:
Even in mild cases, children with HIE may experience differences in attention, learning pace, or emotional regulation.
Evidence & Research:
Considerations for Families:
Resources
Therapies should be tailored to each child’s unique strengths and needs, have meaningful and measurable goals, and be provided by licensed/credentialed providers with specialized training. Multidisciplinary care teams can help families create personalized care plans.
Research into new therapies for HIE is ongoing, with hope for options that may reduce brain injury and/or improve neurodevelopmental outcomes. Hope for HIE is on the forefront of partnerships with the top researchers around the world, bridging patient-family experience, expertise, and support with scientific advancement across the developmental pathway for HIE causation and intervention in neurodevelopment -- fetal through adulthood.
Hope for HIE helps families stay informed and engaged in research. Visit our Clinical Trials & Research Hub to learn about active and upcoming studies, including how families can get involved in shaping future treatments.
Families affected by HIE are often approached with alternative or “miracle” treatments that promise dramatic improvements. It’s important to evaluate these claims carefully, as most do not have scientific rigor, safety data or efficacy data behind them.
Too many families fall victim to good marketing and a 'placebo effect', spending tens of thousands of dollars on ineffective therapies in search for anything that can help their children. These alternative providers prey on the vulnerability of families in their most desperate times.
Financial safety is also critically important to consider as you delve into considering non-evidence based treatments. We work with our Medical Advisory Board to evaluate claims of trending alternative treatments and cover these topics on our blog, our Hype or Hope series, and on social media.
Hope for HIE encourages families to talk to their medical team about any treatment being considered and to consult trustworthy sources. We work to combat misinformation and empower families with facts to make the safest decisions possible.
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