Hypoxic-ischemic encephalopathy (HIE), also known as neonatal encephalopathy, birth asphyxia, and perinatal asphyxia, is a form of brain damage in newborns. The damage results from lack of oxygen and low blood flow.
HIE can lead to permanent disorders and health conditions, including cognitive disabilities, cerebral palsy, hearing and vision impairments, epilepsy, and possibly even death.
This type of newborn brain damage can result from a wide range of complications, many of which are caused or facilitated by a physician’s actions or lack of action.
If your baby suffers from HIE, and you need help determining whether you have a case for medical malpractice, call the Birth Injury Lawyers Group at 1-800-222-9529.
Infant Hypoxic Ischemic Encephalopathy (HIE) Lawsuits & Injury Cases
Within the legal industry, infant hypoxic-ischemic encephalopathy connects very tightly with medical malpractice. Although the medical connection exists, a lawyer cannot just rest on showcasing the obvious: that the pregnancy, labor, or delivery took a wrong turn, and the infant suffered injury as a result.
Rather, your lawyer must prove medical negligence by establishing:
- The level of care and skill that a similarly trained medical provider would have exhibited in a comparable situation (this is called “medical standard of care”)
- How the health care provider failed to meet this medical standard of care
- That this negligence resulted in measurable injury to the newborn
By filing a medical malpractice lawsuit, the parent can at least eliminate the economic concerns resulting from the health care provider’s negligence. A settlement or verdict could yield the following recoverable damages:
- Medical treatment costs (past, present, ongoing, and future)
- Required Surgeries
- Physical rehabilitation
- Counseling
- Physical therapy
- Mobility devices like wheelchairs and other specialized equipment
- Pain and suffering
- Mental anguish
- Emotional distress
- Lost income due to parents caring for the disabled infant/child
- Special education costs as the infant grows to school age
- Loss of a family relationship (loss of consortium)
Infant Hypoxic Ischemic Encephalopathy (HIE) Types
Healthcare providers will conduct a range of tests using various diagnostic tools to rate the extent of damage to the newborn’s brain tissue. Based on such criteria as the appearance of the baby after birth, The Sarnat Scale is used in this regard, as are EEG, ultrasound and MRI, and checking cord blood gas levels.
Infant Hypoxic Ischemic Encephalopathy (HIE) Causes
With all the variables that enter into a pregnancy, labor, and delivery, It can be difficult to pinpoint the cause of a specific occurrence of HIE. Some causes include the following:
- High-risk pregnancy factors – Previous c-sections, high blood pressure, alcohol/drug use)
- Umbilical cord issues – Wrapped cord, underdeveloped cord, true knot, umbilical cord prolapse
- Fetal-maternal hemorrhage – Internal bleeding resulting in significant blood loss by mom and baby)
- Placental problems – Placental insufficiency, abruption, clotting, previa
- Uterine rupture – Due to trauma or vaginal birth after cesarean
- Labor and delivery – Shoulder dystocia and vaginal deliveries when issues should have prescribed an emergency c-section
- Blood clotting disorders
- Post-birth causes – Breathing issues, hypoglycemia/hyperglycemia, meconium aspiration syndrome, infections
Infant Hypoxic Ischemic Encephalopathy (HIE) Symptoms
Depending upon how much the brain is injured and which areas of the brain were impacted, symptoms of HIE can vary. Infants born with HIE may display the following symptoms:
- Floppiness and unresponsive to sounds or sights. On the other hand, sometimes a baby with HIE may act tense and exhibit an unusually strong reaction to stimuli.
- Have abnormal movements or seizures.
- Struggles with weak mouth and throat muscles
- Demonstrates a weak cry
- Exhibits indications of organ dysfunction, particularly in the lungs, blood, kidneys, heart, and liver
Infant Hypoxic Ischemic Encephalopathy (HIE) Diagnosis and Treatment
A physician may suspect HIE when:
- They detect fetal distress or a low heart rate during labor and delivery
- They need to assist the baby with breathing
- The baby has a low heart rate after delivery
A neurologist confirms the HIE diagnosis by monitoring the infant for seizures and signs of brain dysfunction using an electroencephalogram. They will also conduct MRIs to look for any indication of brain injury.
Brain cooling is a method of treating the infant immediately after an HIE diagnosis. The treatment is based on research showing that brain injury can be minimized by cooling the infant’s brain by a few degrees below normal body temperature as soon as possible after birth.
Besides the brain cooling treatment, physicians may administer additional therapies in combination to assist any other HIE-impacted organs, such as the heart, kidneys, liver, and lungs. Medications are administered to newborns suffering from seizures.
Ongoing treatment centers on helping the child manage the various brain-injury-related symptoms with physical, medical, and occupational therapy treatments.
Neonatal Therapeutic Hypothermia
Neonatal therapeutic hypothermia lowers your infant’s body temperature shortly after birth using a blanket of cool water that circulates underneath your baby. Your son or daughter is then maintained and monitored at the lowered temperature for 72 hours before slowly being returned to a normal 98.6 degrees Fahrenheit.
Neonatal therapeutic hypothermia treatments reduce your infant’s body temperature to as low as 91.4 F. This specialized treatment is used to treat infants who have experienced an oxygen deficiency at birth. Your child might continue to reap the benefits of neonatal therapeutic hypothermia well into their early childhood years.
Infant Hypoxic Ischemic Encephalopathy (HIE) Frequently Asked Questions
How do I know if my baby has Infant Hypoxic Ischemic Encephalopathy (HIE)?
Your physician may suspect the occurrence of HIE upon witnessing various signs during labor and delivery. In these cases, a neurologist will conduct various tests to confirm HIE and then check for the extent of brain injury.
Can Infant Hypoxic Ischemic Encephalopathy (HIE) be fatal?
Yes, HIE can be fatal in occasions where oxygen is shut off from the brain for too long, causing bodily systems and functions to stop working.
Who is liable for Infant Hypoxic Ischemic Encephalopathy (HIE)?
From not adequately monitoring a fetus during pregnancy to waiting too long to perform a C-section, anyone—from nurses and midwives to nurse practitioners and obstetricians—can make the error in judgment or execution that leads to infant HIE. They can be liable when they make monumental mistakes at critical moments in how they respond to things like:
- Asphyxiation during childbirth
- The infant requiring resuscitation
- Incorrect readings for cord and fetal blood gases and venous pH levels
- The occurrence of a seizure
- An indication of injury in the brain MRI
- Any abnormality in the infant’s reflexes, activity, and tone
What is the statute of limitations for Infant Hypoxic Ischemic Encephalopathy (HIE)?
How long you have to file a medical malpractice lawsuit varies depending on the state where your child was born. Each state has its own laws that apply in these cases, including a statute of limitations, a statute of repose, and the possibility of tolling for minors. Your attorney can help you understand the deadlines that apply in your case.
How Common Is Hypoxic Ischemic Encephalopathy?
Hypoxic ischemic encephalopathy (HIE) is not very common. It occurs in an estimated 1.5 per 1,000 live births, according to an article titled “Epidemiology of Neonatal Encephalopathy and Hypoxic-Ischaemic Encephalopathy” published by the Journal of Early Human Development in 2010.
What Causes Hypoxic Ischemic Encephalopathy In Newborns?
Many factors may cause hypoxic ischemic encephalopathy (HIE) in newborns, which primarily stems from the restricted flow of oxygenated blood to the brain.
Risk factors for HIE include:
- Maternal medical issues
- Umbilical cord problems
- Fetal-maternal hemorrhage
- Placental problems
- Uterine rupture
- Complications in labor or delivery
- Blood clotting disorders
- Problems after birth
- Cardiac arrest
- Near sudden infant death syndrome (SIDS)
Infant Hypoxic Ischemic Encephalopathy (HIE) Glossary Terms
- Placenta Previa – the opening of the uterus is blocked by the placenta, preventing normal delivery of an infant.
- Apgar Scores – A point system for measuring an infant’s physical condition based on muscle tone, heart rate, skin coloration, respiratory effort, and response to stimulation. Highest possible score is 10.
- Therapeutic Hypothermia – A treatment for limiting brain damage and edema by applying cold to acute injuries.
When the doctor, medical team, or medical facility you entrusted with delivering your baby fails to perform their responsibilities, and your otherwise healthy baby comes into the world with all the burdens of HIE, you deserve compensation.
Call the Birth Injury Lawyers Group to Connect With an Attorney Who Can Help
Let an Infant Hypoxic Ischemic Encephalopathy lawyer represent your rights and see that you receive compensation for your economic losses, as well as your emotional losses. Call the Birth Injury Lawyers Group today at 1-800-222-9529 to find a lawyer who can help with your case.
What Are the Stages of Hypoxic Ischemic Encephalopathy?
When it comes to the question “What are the stages of hypoxic ischemic encephalopathy?” you will find that there are two. Hypoxic ischemic encephalopathy (HIE) presents in the following ways:
- In the first stage, brain cells become damaged immediately following the oxygen deprivation event (low levels of oxygen in the blood or restricted flow of oxygen to the brain).
- In the second stage, “reperfusion injury” occurs when oxygenated blood resumes its flow to the brain, releasing toxins from cells damaged during stage 1.
Understanding HIE
HIE can be best understood by breaking down the meaning of the term used to describe this medical condition.
“Hypoxic” refers to a lack of oxygen, and “ischemic” refers to restricted blood flow, which causes the low oxygen levels. The resulting “encephalopathy” refers to the damage to the brain cells, which immediately begins when the brain becomes deprived of oxygen. When oxygenated blood resumes its flow to the brain, reperfusion injuries begin to manifest.
Causes of HIE
Many conditions can serve as a catalyst for HIE, including:
- Umbilical knots.
- Dangerously low maternal blood pressure.
- Shoulder dystocia.
- Cardiac arrest.
- Uterine rupture.
- Cord compression.
- Placental insufficiency.
- Placental abruption.
- Feto-maternal hemorrhage.
- Trauma during delivery.
- Cord prolapse.
Many factors determine the extent to which the baby’s brain will suffer damage, and for how long, as a result of HIE.
Diagnosing the Severity of HIE
Physicians use the Sarnat classification scale to evaluate the severity of hypoxic ischemic encephalopathy (HIE), and to determine the likely outcomes associated with each stage. The scale consists of the following levels:
- Grade I: Mild
- Grade II: Moderate
- Grade III: Severe
When a doctor detects signs of inadequate or interrupted oxygen flow in the newborn, the provider will classify the infant’s condition according to the following criteria:
- Alertness
- Muscle tone
- Seizures
- Pupils
- Respiration
- Duration
The more severe the infant’s condition related to the above criteria, the higher the grade level associated with the baby’s HIE. The classifications apply to the clinical state of newborns who are more than 36 weeks old, in gestational terms.
When coupled with electroencephalogram results, the identified stage of hypoxic ischemic encephalopathy can help medical providers speak to the baby’s prognosis.
Grade I of HIE
A Grade I stage of HIE is called mild hypoxic-ischemic encephalopathy. It initially presents as an infant who is hyperalert. Their muscle tone is normal, they exhibit overactive stretch reflexes, and they may demonstrate brisk deep tendon reflexes. The infant may not feed well and can show irritability, as well as unusual levels of sleepiness or crying. These signs may resolve themselves within 24 hours without any other effects.
Grade II of HIE
At the Grade II stage of HIE, known as moderately severe hypoxic-ischemic encephalopathy, the newborn will seem lethargic. Their muscle tone is floppy, a condition known as hypotonia, and the baby shows weakened deep tendon reflexes. Sucking reflexes, grasping, and the Moro reflex in response to loss of support are either slow and weak, or entirely nonexistent. Periodically, the baby experiences apnea. Within 24 hours of birth, seizures may begin.
With Grade II HIE, the newborn may experience a full recovery within a couple of weeks and have a more promising long-term outcome. However, it is possible for a newborn to show signs of mild HIE or even wellness, but then begin to deteriorate in condition, with intensified seizures and other signs of continuous brain cell dysfunction.
Grade III of HIE
Grade III HIE comprises all the signs and symptoms of severe hypoxic-ischemic encephalopathy. The newborn can be unresponsive to physical stimuli and may appear to be in a stupor—or possibly even a coma. Irregular breathing might prompt the required use of a mechanical ventilator.
The infant shows no swallowing, Moro, sucking, or grasping reflexes. Eye motion appears deviated, and pupils, which may be dilated, may not react well to light. Typically, hypotonia presents itself with depressed deep tendon reflexes.
With Grade III, the infant experiences intense seizures, which subside as tissue suffers damage from the return of blood supply (reperfusion injury). As this damage progresses, the infant will be awake less and less. Fluid buildup can cause a swelling of the fontanelle. The newborn’s blood pressure and heart rate become irregular and may lead to death from cardiorespiratory failure.
Aftermath of Grade III HIE
When a newborn survives the initial threats of Grade III HIE, their alertness will heighten within five days. However, from this point they may face several challenges, as follows:
- Feeding difficulties, necessitating the use of a feeding tube
- Continued hypotonia
- Heart problems, including severe hypotension
- Severe pulmonary hypertension, demanding use of a ventilator
- Renal failure that causes imbalances of electrolytes and water
- Elevated blood ammonia levels from a dysfunctional liver
- Gastrointestinal dysfunction
- Brainstem compression
- Rupture of the great cerebral vein
- Cranial hematoma
Care and treatment of the infant who survives the third stage of HIE may require weeks or months of hospitalization and/or hospital visits.
At Any Stage of Hypoxic Ischemic Encephalopathy Your Doctor’s Negligence May Be to Blame
Medical providers’ treatment during pregnancy, labor, delivery, and post-delivery can play a significant role in preventing or facilitating HIE in a newborn. If a healthcare professional’s negligence caused your child’s HIE, you are entitled to pursue a medical malpractice action against them.
Call the Birth Injury Lawyers Group today at (800) 222-9529 for a free case review.
Is Hypoxic Ischemic Encephalopathy Curable?
Given today’s current scientific understanding, hypoxic ischemic encephalopathy (HIE) is not curable. However, if administered within six to 24 hours after the oxygen-depriving event, a treatment called therapeutic hypothermia can help decrease the degree of permanent brain damage from the condition.
Beyond immediate hypothermia treatment, the baby will likely suffer enduring brain damage. Babies with HIE can still benefit from a variety of therapies and treatments that will help to minimize the negative effects and boost function.
About Therapeutic Hypothermia
It is vital for the post-delivery medical team to swiftly identify signs and diagnose HIE in a newborn. The baby’s best chance to avoid severe brain damage is to receive hypothermia treatment within six hours from birth (or from the incident in which they did not receive enough oxygen). This treatment is also known as “cooling therapy” or “neonatal cooling.”
Before doctors can administer the treatment, the newborn must meet specific requirements with regard to weight, gestational age, and other criteria. If the attending physician approves the baby for hypothermia treatment, doctors will apply a cooling cap to the baby’s head, or perhaps a device that cools the entire body. This treatment continues for three days. When this period has passed, doctors begin to gradually warm the infant back to a normal temperature of 98.6 degrees.
Sometimes, plasma and blood cell transfusions can be implemented to address issues with the body’s ability to form blood. Generally, the infant’s organs recover within one week following this treatment, although the baby may still suffer from brain damage. Depending on the severity of the brain damage, the infant might experience a range of lifelong effects, from delayed development or learning disorders to cerebral palsy. In the most extreme cases, the infant who experienced severe asphyxiation will not survive.
Other Treatments for HIE
When a newborn receives an HIE diagnosis, they may have to endure various types of treatments aimed at helping the infant’s struggling organs. Doctors might implement measures to sustain liver and kidney function, modulate blood pressure, and support the heart. They might also administer medications to control seizures. If the infant is not able to breathe sufficiently on their own, they could be placed on a mechanical ventilator.
Diagnosing and Testing for HIE
Timing for hypothermia treatment is critical. If this therapy does not occur within the first six hours or so, chances for minimizing permanent brain damage drop dramatically. This is one reason it is so important that labor and post-delivery teams be extra vigilant when it comes to observing the baby to check for signs of HIE.
Signs of HIE
While the fetus is still in the womb, doctors may note the presence of meconium (fetal stool) in the amniotic fluid. This may indicate that the fetus experienced distress and it can be linked to HIE, although this connection is not definite. More reliable signs that merit concern include variability in fetal movement and heart rate.
If hypoxia-ischemia damages the brain, it will develop within a 36-hour timeframe into HIE. From there, the infant can experience:
- Seizures.
- Poor feeding.
- Floppy, weak muscles (hypotonia).
- Epileptic activity.
- Unusual pupils.
- Irregular reflexes, breathing, and heart rate.
- Abnormally low level of consciousness that endures up to two weeks.
The infant’s organs–particularly the lungs, liver and blood, heart, and kidneys–may also show signs of dysfunction. The newborn will have a low birth weight and low Apgar scores as well.
Additional Tests for HIE
If medical providers detect the possible presence of HIE, they will typically swiftly initiate further lab tests and radiological evaluations. Magnetic resonance imaging (MRI) and other neuroimaging tests may confirm the HIE diagnosis. Newer diagnostic methods include MR spectroscopy and diffusion-weighted imaging.
How HIE Happens
Early Human Development’s “Epidemiology of Neonatal Encephalopathy and Hypoxic-Ischaemic Encephalopathy” states that HIE develops in around 1.5 out of every 1,000 live births.
Although the precise cause has yet to be determined, medical scientists have noted a number of apparent risk factors that heighten the chance for asphyxia, as follows:
- Intrapartum hemorrhage
- Uterine rupture
- Placental abruption
- Acute maternal hypotension
- Lungs not working at capacity
- Complications with umbilical cord
- Trauma
- Pressure to the baby’s cranium
- Interrupted oxygen supply/breathing
- Heart complications
These are just a few of the risk factors that can cause brain asphyxia, cutting oxygen supply to the baby’s brain and leading to HIE.
Hypoxic Ischemic Encephalopathy Is Not Curable and You May Need Help
There are many things a medical provider can do that create the conditions leading to HIE. Sometimes, a healthcare professional’s lack of action can cause this serious condition. Either way, if medical negligence caused your child’s HIE, you may be eligible to recover damages to pay for medical treatment, medications, and other losses.
Call the Birth Injury Lawyers Group today at (800) 222-9529 for a free consultation.