Hypoxic-ischemic encephalopathy (HIE), sometimes called “birth asphyxia” or “neonatal encephalopathy” is a serious form of brain damage that often arises from medical malpractice.
This damage occurs to babies either directly before or during birth when their blood is insufficiently oxygenated.
There are several reasons why HIE develops, including high-risk pregnancy conditions and or an unexpected problem that occurs during labor or delivery. However, HIE is also often a direct result of specific actions taken by a medical professional, or failure to take appropriate action to prevent HIE from occurring.
Some of the most frequent factors associated with HIE include:
When the brains of children are denied access to necessary oxygen, cells begin dying off quickly and in vast numbers. This leads to irreversible brain damage. Should HIE occur, physicians will attempt to address the problem through an intervention called “therapeutic hypothermia,” which cools the brain and helps prevent damage. During this procedure, the baby’s body temperature is lowered to as low as 92 degrees. This lowers the body’s metabolic rate and can arrest the spread of brain damage.
Medical professionals are trained to quickly diagnose HIE and take steps to prevent or mitigate injury. If babies have low APGAR scores (a test that assesses the post-delivery health of a baby), refuse to feed, have seizures, have organ problems or breathing issues, that child may be experiencing HIE.
To make a definitive diagnosis, medical professionals will often rely on scans, MRIs, EEGs and ultrasounds.
Unfortunately, some cases of HIE are not diagnosed, and developmental disorders may not appear until the child is older. This means it is essential that medical professionals take diagnostic steps if birth trauma or other co-factors are present.
While the public may not be especially aware of HIE, prevalence of the condition is relatively high, occurring in 1.5 of 1,000 live births. It is believed that HIE is responsible for nearly one quarter of all neonatal deaths globally. Children who survive often have longstanding developmental disabilities. These issues may include cerebral palsy, epilepsy etc.
The severity of HIE aftereffects depend on the level of blood oxygen insufficiency present and how long the episode lasts.
Older children and adults can also suffer from a lack of oxygen to the brain. These incidents are often precipitated by cardiac issues, strokes or other major medical maladies.
While hypoxic-ischemic encephalopathy can have debilitating lifelong consequences, it can also be treated with therapeutic hypothermia, greatly improving the prognosis for the baby in question. This means that early detection of HIE is absolutely critical.
Treatment must be started shortly after birth (within six hours, generally) to be effective. This gives caregivers a brief window to make a diagnosis and begin working to prevent or minimize brain damage from HIE.
While all babies who were oxygen deprived in utero or during delivery need to be tested for HIE, there are some other markers that caregivers should identify as being possible symptoms of HIE. These include:
Tests for HIE detection include the APGAR score, which is used to assess the overall health of newborns. APGAR stands for Appearance, Pulse, Grimace, Activity, Respiratory effort.
Caregivers may also test for HIE by using MRIs, CAT scans and other imaging technology (to identify brain injuries related to oxygen deprivation), umbilical cord blood gas tests (which can determine if cord blood was low in oxygen) and EEGs, which can detect seizures.
Unfortunately, these telltale signs are sometimes missed for months or even years after the birth, when developmental delays become obvious. To combat these effects, prompt detection is essential -- and failure to do so in many cases amounts to malpractice.
Hypoxic-ischemic encephalopathy (HIE) is a form of brain damage that occurs when newborn babies suffer from reduced blood flow to the brain/limited oxygenation. Other common terms for HIE include perinatal asphyxia, birth asphyxia and neonatal encephalopathy.
Many HIE cases are directly caused by medical malpractice -- and the consequences of these actions are often severe and lifelong for victims. These consequences include serious, permanent brain damage or death in the worst cases.
Let’s take a closer look at some of the most common HIE scenarios.
Women who suffer from conditions such as preeclampsia and gestational diabetes need to be carefully monitored throughout pregnancy. Failure to do so can have fatal repercussions. In cases where these conditions are not given the proper level of attention and treatment, HIE may be the end result.
The umbilical cord connecting mothers and babies is an essential conduit for supplying oxygen and nutrients and removing fetal waste products. If, during the delivery, the umbilical cord is compressed or damaged, oxygen may be cut off, leading to the development of HIE.
The mother’s placenta and uterus are also critical to the process of providing babies with oxygenated blood. If the placenta separates from the uterus too early; if the placenta is not delivering sufficient blood or is too close to the cervix, or if the uterus is torn, HIE may subsequently develop.
Other Commons Ways for HIE to Develop
Neonatal HIE requires immediate medical intervention to improve the patient’s long-term prognosis. The first step is a procedure called “brain cooling” or “hypothermia treatment,” during which the baby’s brain temperature is reduced several degrees below the human body’s baseline temperature.
Babies are placed on a cooling blanket and fitted with a cooling cap, typically for three days, and are given medicines to assist with discomfort. A machine circulates water through the cap to bring the baby’s temperature to 91 degrees, slowing the metabolic rate and limiting cell damage. Following the cooling treatment, the baby is gradually returned to normal human temperatures.
During this procedure babies are closely monitored. Heart rate, breathing, temperature are all tracked and brain activity is often monitored through the use of an electroencephalogram, which checks for cerebral function. By placing small probes on the baby’s scalp, medical caregivers can monitor for possible seizures.
During cooling periods, babies typically have lower heart rates, slowed breathing and may appear sleepy. However, they may be touched and soothed in some cases and will receive necessary nutrition via IV.
In addition to brain cooling, HIE may be treated with other therapies designed to treat organs affected by the condition. This may include mechanical ventilators or ECMO machines to assist with breathing and other critical life functions.
Once neonatal treatment is complete, babies with HIE often receive medical, physical and occupational therapy to help manage symptoms related to HIE.
With timely intervention and follow up, outcomes for babies with HIE can be significantly improved.
While HIE is a dangerous condition that can irretrievably change lives, there are laws that allow victims of medical malpractice to receive justice. It’s critically important, however, to work with an attorney specializing in HIE cases. Given the deep complexity of this litigation, experience is key.
Medical malpractice cases are often deeply complex. This means that it is imperative to work with an attorney well-versed in HIE.
At Michels & Lew, we have the experience to handle HIE cases regardless of their complexity. If you need assistance, please don’t wait to reach out to us today for a consultation.