Understanding Hypoxic Ischemic Encephalopathy (HIE)

Hypoxic-ischemic encephalopathy (HIE) is a type of brain damage that occurs when the brain doesn't receive enough oxygen (hypoxia) or blood flow (ischemia). This lack of oxygen and nutrients can cause cells in the brain to die, leading to permanent brain damage or changes to the brain’s health and chemistry (encephalopathy).

HIE is most commonly seen in newborns, particularly those who have experienced complications during birth or a birth injury such as cord prolapse, placental abruption, or other issues that interfere with oxygen supply. However, it can also occur in adults due to cardiac arrest, respiratory failure, or near-drowning incidents.

What are the Symptoms of HIE?

Hypoxic-ischemic encephalopathy (HIE) can present differently in newborns and adults due to the varying causes and stages of brain development. HIE often leads to a diagnosis of Cerebral Palsy. Often times, health care providers do not want to disclose to parents that their baby has been injured at birth. Parents should pay close attention to the behaviors and health of their children, especially newborns and infants, to look for common signs of HIE or another similar brain-related birth injury.

Newborns may show these symptoms of HIE:

• Difficulty with or absence of breathing: This is often the first sign and can occur immediately after birth.
• Low muscle tone or difficulty moving: The newborn may appear limp or have trouble moving.
• Seizures: These can start within the first 24 to 48 hours after birth.
• Difficulty feeding: The baby may have trouble sucking or swallowing or may not show interest in feeding.
• Low heart rate or poor circulation: There may be signs like a weak pulse or blue coloration in the skin.
• Reduced reflexes: The baby may not respond normally to touch or other stimuli.
• Abnormal level of consciousness: The baby could be excessively sleepy or difficult to wake up.

Adults with HIE may experience these difficulties as a result of the lifelong brain damage:

• Cognitive problems: This can include issues with memory, attention, or thinking clearly.
• Physical problems: These can range from weakness or numbness in certain parts of the body to more severe issues like paralysis.
• Seizures: Like in newborns, seizures can also occur in adults with HIE.
• Loss of consciousness: In severe cases, individuals may become unresponsive or fall into a coma.
• Mood changes: Depression, irritability, or other changes in mood or behavior can occur.

What are the Causes of HIE Birth Injuries?

Hypoxic-ischemic encephalopathy in newborns is a severe brain injury that results from oxygen deprivation and limited blood flow to the brain. It can be caused by various factors, but many cases involve medical errors during pregnancy or childbirth.

Types of medical malpractice that can cause HIE in a newborn include the following and more:

• Delayed delivery: If there are complications during labor and delivery, it's crucial for medical providers to act quickly. A delayed delivery can result in the baby being deprived of oxygen.
• Mismanagement of fetal distress: Fetal distress is a term used to indicate the baby is not doing well in the womb. This could be due to low oxygen levels, slow heart rate, or other problems. Medical providers must closely monitor the health of the mother and her child before, during, and after labor and childbirth for signs of fetal distress.
• Failure to detect or treat maternal infections: Some infections in the mother can lead to inflammation of the fetal membranes and potentially cause HIE. Medical providers should screen for and treat these infections promptly.
• Improper use of delivery instruments: Tools like forceps and vacuum extractors can help with delivery but, if used improperly, can cause head trauma leading to HIE.
• Failure to perform a C-section when necessary: In some cases, a C-section is the safest way to deliver a baby. If a medical provider fails to recognize this need, it can result in HIE due to prolonged oxygen deprivation.

Can HIE Be Treated in Newborns?

Once HIE is identified in a newborn, it can be treated in some ways. The birth injury has likely caused permanent damage once it occurred, but some treatments may lesson the severity of lasting symptoms. For this reason, it is crucial for HIE to be identified quickly and treated correctly.

Treatment options that might help a newborn child diagnosed with HIE are:

• Therapeutic hypothermia: This is currently the standard treatment for moderate to severe HIE in newborns. The baby's body temperature is lowered to around 92.3 degrees Fahrenheit for 72 hours. This treatment slows down the metabolic processes, reducing the rate of brain cell death and potentially limiting the extent of brain damage.
• Seizure management: Seizures are a common symptom of HIE and can cause further brain injury if not managed properly. Anti-seizure medications can be used to control seizures.
• Respiratory support: Many babies with HIE may have difficulty breathing. They may require oxygen or even mechanical ventilation to help them breathe.
• Cardiovascular support: Some newborns may need medications to support their heart function and blood pressure.
• Neonatal intensive care: Close monitoring in a neonatal intensive care unit (NICU) is often necessary for babies with HIE. This allows for immediate intervention if complications arise.
• Rehabilitation therapies: As the baby grows, they may benefit from physical, occupational, and speech therapy to address developmental delays and physical impairments.

Can Medical Providers Be Held Liable for Causing HIE?

Medical providers can be held liable for causing HIE in newborns if it's determined that their negligence or deviation from standard care directly resulted in the condition. Medical malpractice occurs when a healthcare provider fails to provide the standard of care that a reasonably competent medical professional would have provided in similar circumstances, leading to injury or harm.

If a parent suspects that their child's HIE was caused by medical negligence, they may choose to take legal action against the healthcare provider. A law firm that handles birth injury claims can help evaluate the case, gather evidence, and determine the most appropriate course of action. They can guide parents through the complex legal process, ensuring their rights are respected while they pursue compensation and justice in their child’s name.

Cullan & Cullan has four lawyers who are also doctors. Our firms primary focus is birth injury HIE cases. We handle cases in Missouri, Kansas, and select cases nationwide. We use our medical backgrounds to get into the fine, complicated details of medical malpractice and birth injury cases; we’re able to see the sides of a case that other attorneys cannot due to this distinction. If your child has been diagnosed with HIE, call us first by dialing (816) 253-8606 or filling out an online contact form.