Children with hypoxic-ischemic encephalopathy (HIE) may require breathing aids due to a number of factors, including muscle weakness and prematurity-related conditions. In cases of moderate to severe HIE, multiple organ systems may be impacted by the oxygen deprivation at birth, and this can sometimes impact the respiratory system as well. Throughout this page, we’ll discuss considerations related to respiratory health issues in children with HIE and other special needs.
Causes of Respiratory Health Issues in Children with HIE and Special Needs
Children with hypoxic-ischemic encephalopathy may have respiratory conditions due to a wide variety of factors:
- Lower quantities of exercise due to physical limitations
- Greater risk of swallowing or feeding limitations (dysphagia), which can promote choking and aspiration
- Chest wall deformity due to spinal curvature causing labored breathing, restricted lung function, and respiratory difficulty
- Prematurity, which increases the risk to babies for bronchopulmonary dysplasia and respiratory distress syndrome (RDS)
- More difficulty in obtaining sufficient nutrition, which can cause weakness and/or atrophy, which in turn impacts lung function
- Difficulty clearing airways due to muscular dysfunction
Diagnosis, Treatment and Therapy for Respiratory Health Conditions
Children with chronic chest infections, pneumonia, aspiration or coughing should be closely monitored and potentially referred to a certified respiratory therapist (CRT) or other professional (such as a gastroenterologist, dietician or speech-language pathologist (SLP). These professionals can screen for risk factors that contribute to serious health conditions (such as aspiration, pneumonia, and respiratory failure). They will measure a patient’s lung capacity, blood oxygen levels, blood pH, and CO2 levels, and make note of any physical issues that make breathing harder (such as scoliosis, kyphosis, pectus excavatum, pectus carinatum, or barrel chest). They can then recommend respiratory interventions that will help reduce health risks and improve respiratory function. These interventions can include respiratory exercises, vest therapy, inhalers/nebulizers, modified diets, speech therapy, oxygen treatment, prophylactic antibiotics or short-term intubation. They can also help the child develop ways to cough and clear airways more efficiently, exercise their lungs to improve breathing efficiency, and develop ways to position their bodies to improve ventilation. They may also initiate therapies such as hydrotherapy, high frequency chest wall oscillations, percussion and chest wall vibrations and suctioning to help remove mucus and build up, and remedy obstructions.
Respiratory therapy is not something that a child would receive on a regular schedule the same way that they would receive physical or occupational therapy. Respiratory therapists provide general advice for daily living and can monitor children with feeding tubes, as these individuals are more likely to develop a respiratory condition that may need addressing. Respiratory therapy can address:
- Breathlessness, chest rattling, postural drainage, secretions that obstruct airways, wheezing and strained breathing
- Dysphagia and related issues (GERD, aspiration, gagging, trouble chewing/swallowing)
- Pneumonia, chest infections and recurring cough
- Aspiration of food and/or liquids
- Unexplained fatigue
- Asthma, bronchitis and bronchiolitis
- Prevention of serious complications, including failure to thrive, aspiration, heart and lung trouble, malnourishment, and respiratory failure
- Baskett T, et al. Predictors of respiratory depression at birth in the term infant. BJOG 2006; 113:769–774.
- Douglas-Escobar, Martha, et al. Hypoxic-Ischemic Encephalopathy: A Review for the Clinician. JAMA Pediatrics; doi: 10.1001/jamapediatrics.2014.3269