Hypoxic Ischemic Encephalopathy (HIE) and Birth Asphyxia

Hypoxic Ischemic Encephalopathy (HIE) and Birth Asphyxia Attorneys and Birth Injury Attorneys of Michigan serving Detroit, Grand Rapids, Michigan, Ohio and Washington D.C.

The birth injury attorneys at Reiter & Walsh ABC Law Centers have helped many families affected by hypoxic ischemic encephalopathy (HIE). We are nationally recognized as one of the top birth injury firms in the nation and have earned the reputation for compassionate yet aggressive legal assistance. Our attorneys have the expert resources and experience to determine the cause of HIE and will take appropriate action if malpractice or negligence played a role.

What is Hypoxic Ischemic Encephalopathy?

Hypoxic Ischemic Encephalopathy (HIE), commonly known as birth asphyxia, is a lack of oxygen and blood flow to the baby’s brain at or near the time of birth. HIE is estimated to occur in about 2-9 per 1,000 live births. Roughly 10–60% of affected infants die in the newborn period and at least 25% of those that survive have significant long-term neurodevelopmental impairments.

Oxygen is necessary to sustain critical cells within the body, most notably brain cells. When the brain does not receive proper oxygenation, cell death occurs. This lack of oxygen and subsequent cell death (brain damage), can result in mental and physical disabilities such as intellectual and developmental disabilities, learning disabilities, cerebral palsy and seizures. The extent and seriousness of the damage depends on the length of time that the baby was deprived of oxygen and the condition of the baby prior to the oxygen deprivation.  Generally speaking, the longer an infant goes without oxygen or with decreased oxygen, the more severe and permanent the injury will be. Even as little as 5 minutes without oxygen can cause significant brain damage.

Causes of HIE

There are many situations during labor and delivery that can cause HIE. These include:

• Umbilical cord injuries such as a nuchal cord (the cord gets wrapped around the baby’s neck); a prolapsed cord (the umbilical cord precedes the fetus' exit from the uterus,  the cord becomes compressed and unable to deliver oxygen to the baby); umbilical compression due to hyperstimulation (excessive uterine activity).
• Problems with the placenta or uterus such as a ruptured uterus; placenta previa (placenta is attached to the uterine wall close to or covering the cervix); placental abruption (portion of the placental lining tears away from the uterus) and placental insufficiency.
• Tachysistole (excessively frequent uterine contractions).
• Elevated fetal heart resting tone in between contractions or fetal monitoring errors.
• Trauma to or hemorrhages in the baby’s brain during delivery.
• Complications related to the baby’s size or position such as breech or cephalopelvic disproportion (baby’s head is too large to fit through the mother’s pelvis).
• Delayed delivery of the baby, delayed emergency C-section.
• Undiagnosed or improperly treated conditions in the mother such as high blood pressure (preeclampsia) or infection.

Signs and symptoms of hypoxic ischemic encephalopathy

Signs and symptoms of HIE at birth may include the following:

• Resuscitation of the newborn at birth.
• Low APGAR Scores for longer than 5 minutes.  An APGAR score assesses the overall health of a newborn over the first few minutes of life. It assigns scores to things like the baby's skin color / complexion, pulse rate, reflexes, muscle tone, and breathing.
• Seizures within the first 24 – 48 hours of delivery.
• Difficulty feeding, including inability to latch, suck or swallow.
• Profound metabolic or mixed acidemia in an umbilical artery blood sample (the baby's blood is acidic/has a low ph.).
• Hypotonia (low muscle tone).
• Abnormal limpness.
• Multiple organ problems (e.g., involvement of the lungs, liver, heart, intestines).
• No brain stem reflexes (e.g., breathing problems and an abnormal response to light, and only blood pressure and heart function reflexes are functioning).    
• Coma.

Diagnosis of HIE

Hypoxic ischemic encephalopathy is confirmed through tests and neuroimaging studies, such as:  CT scans, PET scans, MRIs, blood glucose tests, arterial blood gas tests, EEGs, and ultrasounds. In order to perform these tests, doctors must first suspect hypoxic ischemic encephalopathy. If birth was traumatic or the newborn is exhibiting any of the signs and symptoms above, HIE might be suspected. Sometimes, however, it may not surface until later when a child is exhibiting impaired motor function, delayed growth, and delayed developmental milestones.

Treatment for HIE

Traditional treatment of HIE has been supportive care to limit brain damage and prevent further injury. Specifically, this meant conventional measures such as ventilation, NICU care, controlling or preventing seizures, maintaining blood glucose and pressure, minimizing cerebral swelling, and receiving care from specialty physicians. 

Recently, however, a new therapy called hypothermia or brain cooling has been introduced specifically for HIE. It has shown to improve the outcome of babies with birth-associated HIE by reducing the severity of neurological injury. The treatment consists of lowering a newborn’s body temperature to around 91 degrees Fahrenheit for a period of about 72 hours. Lowering the baby’s temperature slows the metabolic rate allowing cell recovery over a longer period of time. This avoids further damage that can occur if normal oxygenation or blood flow is restored too quickly to injured cells.

Do you have a case?

At Reiter & Walsh ABC Law Centers, we have extensive experience handling birth injury cases involving hypoxic ischemic encephalopathy (HIE). If your child experienced a lack of oxygen during birth or did not receive brain cooling treatment in a timely manner, call our Michigan birth injury attorneys at (888) 419-BABY. We handle cases in Detroit, Grand Rapids, Toledo, Columbus, Washington DC and more locations. You may be entitled to compensation for negligence or pediatric malpractice.