Which of the following is a sign of HIE?

• A. Difficulty sucking/swallowing
• B. Jaundice within first hour
• C. Elevated reflexes
• D. Rapid weight gain

Answer: (A)

Difficulty with sucking and swallowing points to an oromotor and brainstem–cortical disruption that can follow a hypoxic-ischemic injury in a newborn. When the brain experiences hypoxia–ischemia, the neural circuits coordinating suck–swallow–breath can become impaired, leading to a weak or uncoordinated suck and difficulty swallowing. This feeding difficulty is a practical, early sign of neurologic involvement from HIE because it directly reflects impaired neural control of feeding reflexes.

By contrast, jaundice that appears within the first hour is more typical of conditions causing rapid bilirubin rise, not the neurological injury itself, and rapid weight gain isn’t a hallmark of HIE and can point to other issues. Elevated reflexes aren’t the classic early finding in HIE, where tone may be decreased or fluctuating and seizures can occur as the injury progresses. So the presence of a weak suck and poor coordination for feeding best signals possible hypoxic-ischemic brain injury in a newborn.