A newborn baby developed hypoxic ischemic encephalopathy (HIE), brain damage and severe cerebral palsy because she wasn’t getting enough oxygen in the womb when a placental abruption occurred. In fact, the fetal heart monitor showed that the baby’s heart rate was extremely low – only 30 beats per minute. Doctors delayed the emergency C-section the baby desperately needed. At birth, the little girl was lifeless, and it took over 10 minutes for the resuscitation team to arrive to provide critical life-saving maneuvers. The placental abruption had also caused the baby to lose blood and she needed blood products to increase her very low blood pressure. This crucial treatment was also delayed, further depriving her brain of adequate blood flow. The delayed emergency C-section and delayed treatments after birth caused severe hypoxia (low oxygen in the baby’s blood) and ischemia (reduced blood flow) in the baby’s brain, resulting in a type of neonatal encephalopathy called hypoxic ischemic encephalopathy (HIE). The HIE caused so much injury to the baby’s brain that she had seizures and permanent brain damage and was later diagnosed with spastic cerebral palsy (CP).
If your child experienced a birth injury and now has seizures, HIE, brain damage, cerebral palsy or any other long-term condition, contact Reiter & Walsh today at 888-419-2229. Our award winning birth injury lawyers are available 24/7 to speak with you; no fees are ever paid to our firm until we win your case.
Birth Asphyxia and Hypoxic Ischemic Encephalopathy (HIE): When the Baby Experiences Oxygen Deprivation in the Womb
When the baby is in the womb, she receives all her oxygen from oxygen-rich blood delivered to her through the placenta. Oxygenated maternal blood diffuses through vessels that run through the placenta, which is called the uteroplacental circulation. The oxygen-rich blood travels to the baby through a vein in the umbilical cord. Oxygen-depleted blood travels from the baby through arteries in the umbilical cord, and then diffuses back into the maternal circulation through the placenta.
Indeed, the umbilical cord, placenta and uterus (womb) play critical roles in transporting oxygen to the baby. Anything that affects blood flow to the baby can cause her to be deprived of oxygen. When brain cells don’t receive enough blood, oxygen and glucose for a prolonged period of time, a cycle of injury starts to occur. Brain injury caused by insufficient oxygen and blood flow is called hypoxic ischemic encephalopathy (HIE). HIE usually occurs in term babies, although premature babies can also develop the condition. Insufficient oxygen and blood flow in a premature baby usually cause the baby to develop periventricular leukomalacia (PVL), but term infants can also be develop PVL. Hypoxic ischemic encephalopathy usually involves damage to the basal ganglia, cerebral cortex or watershed regions of the brain, but it sometimes includes PVL.
Hypoxic ischemic encephalopathy and periventricular leukomalacia often lead to permanent brain damage and conditions such as the following:
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Learning Disabilities
- Motor disorders
Placental Abruption and Other Conditions that Can Cause Birth Asphyxia and HIE
In the tragic case discussed above, the mother had a placental abruption, which is when the placenta, which is an organ attached to the womb, tears away from the womb, either partially or completely. This is a very dangerous condition because a partial placental abruption can turn severe very quickly. When there is a complete placental abruption, the baby will be totally cut off from her supply of oxygen-rich blood. Quick delivery is required in all cases of placental abruption when the baby is at or close to term. When the baby is premature, immediate delivery usually occurs if the abruption is moderate to severe. When there is a mild placental abruption affecting a premature baby, the mother and baby must be closely monitored, which is best done in a hospital. If the placental abruption starts to get worse or the baby shows signs of distress, delivery must take place right away. In short, whenever a placental abruption starts to cause a premature or term baby to receive insufficient oxygen, delivery by C-section should occur without delay.
Listed below are conditions that can cause birth asphyxia, hypoxic ischemic encephalopathy (HIE) and periventricular leukomalacia (PVL) in a baby:
- Umbilical cord problems, such as a nuchal cord (cord wrapped around baby’s neck), umbilical cord prolapse and compression, short umbilical cord and cord in a true knot
- Ruptured uterus
- Placental abruption
- Vasa previa
- Placenta previa
- Preeclampsia / eclampsia
- Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis. This can greatly decreases the supply of oxygen-rich blood going to the baby, causing birth asphyxia.
- Oligohydramnios (low amniotic fluid)
- Premature rupture of the membranes (PROM) / premature birth
- Prolonged and arrested labor
- Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery. Forceps and vacuum extractors can cause brain bleeds. Sometimes intense contractions (hyperstimulation) caused by labor induction drugs (Pitocin and Cytotec) can cause head trauma. Mismanagement of macrosomia, cephalopelvic disproportion (CPD), abnormal presentations (e.g., face or breech presentation), and shoulder dystocia also put the baby at risk of experiencing birth trauma and birth asphyxia.
- Hyperstimulation caused by Pitocin and Cytotec can cause oxygen deprivation that gets progressively worse.
- Fetal stroke
- Postmaturity syndrome
- Placental insufficiency and intrauterine growth restriction (IUGR). Babies with IUGR often do not tolerate labor well.
The baby in this case also didn’t receive appropriate treatment following birth. Hospitals must be adequately staffed so that right after birth, any mother or baby who needs emergency intervention and resuscitation can get it immediately. The medical team must also properly communicate so that critical medications and treatments can be ordered the instant it is known they will be needed. In this case, someone from the team should have called and ordered blood products for the baby as soon as the severe placental abruption was recognized. This way, the baby could have started receiving the products soon after birth.
Seizures Are Often One of the First Signs of HIE (Hypoxic Ischemic Encephalopathy)
Hypoxic ischemic encephalopathy (HIE) is the most common cause of neonatal seizures; when seizures occur, the medical team should be alert to the fact that the baby may have brain damage. Seizures must be promptly diagnosed and treated, because each seizure has the potential to cause further brain damage in the baby.
Seizures are caused by abnormal electrical discharges in the brain due to nerve damage or problems with the brain’s chemistry. Seizures can cause involuntary jerking movements lasting from a few seconds to a few minutes and can affect normal brain functioning. They sometimes affect consciousness.
Seizures are classified as subtle, clonic, tonic or myoclonic:
- Subtle seizures are often difficult to observe. They occur most frequently in premature babies and are the most frequent type of infant seizures, comprising about 50% of all seizures that occur during the newborn period. There may be some bicycling-type movement, fixation of gaze, or repetitive facial movements.
- Clonic seizures are characterized by a slow, rhythmic jerk of one part of the body. This type of seizure represents about 25% of all seizures during the neonatal period.
- Myoclonic seizures involve rapid twitching or jerking movements and are the most serious, often indicating severe brain damage. Premature babies are the most affected by myoclonic seizures.
- Tonic seizures account for about 5% of infant seizures and cause sustained contractions. Sometimes the eyes may roll upward and breathing may stop for a period of time.
In addition to hypoxic ischemic encephalopathy (HIE), common causes of neonatal seizures include the following:
- Infection. Group B Strep, cytomegalovirus, herpes simplex virus (HSV – herpes encephalitis) and meningitis (meningoencephalitis) are common infections that can cause a baby to have seizures. The most common cause of neonatal infection is untreated infection in the mother that is transmitted to the baby through the birth canal at birth. It is the doctor’s responsibility to screen for various infections during the pregnancy and appropriately treat the mother. If it is suspected that the mother has infection at the time of delivery, antibiotics often need to be given at that time because the will transfer to the baby. If it is suspected that the baby has or was exposed to infection, the baby should be closely monitored and treated for infection in the neonatal ICU.
- Traumatic brain injury. Traumatic brain injuries can be caused by a medically mismanaged problem with the size or position of the fetus relative to the birth canal. For example, sometimes a baby’s head is too large for the mother’s pelvis (cephalopelvic disproportion) or the baby may just be very large (macrosomic). Again, it is the responsibility of the doctor to prenatally check and plan for these types of obstetrical problems. Traumatic brain injuries can also occur from the use of instruments like forceps or vacuum extractors during delivery. Forceps resemble salad tongs. Proper placement requires that the tongs lie evenly against a baby’s head in a location where they are not likely to cause damage. If the forceps are applied unevenly to the baby’s head, skull fractures as well as intracranial hemorrhages (brain bleeds) can occur. Vacuum extractors use suction to pull a baby from the birth canal during a contraction. A small plastic cup is attached to the baby’s head. If the cup is not correctly placed, hemorrhages and blood clots can occur. Doctors must use forceps and vacuum extractors correctly and at the right stage of labor in order to avoid causing brain bleeds, brain damage and seizures in the baby.
- Prolonged second stage of labor. The second stage of labor occurs from the time the mother is fully dilated until the baby is delivered. When this period lasts more than four hours it is considered to be a prolonged second stage. A prolonged second stage is most often associated with cephalopelvic disproportion. Abnormal presentation of the baby, such as a face or breech presentation, can also cause labor to be prolonged. These conditions are associated with birth trauma and birth asphyxia and can cause brain damage, hypoxic ischemic encephalopathy and seizures.
Hypoxic Ischemic Encephalopathy (HIE) and Brain Damage Often Cause Cerebral Palsy
Hypoxic ischemic encephalopathy can evolve and cause permanent brain damage and cerebral palsy in a baby. Sometimes, however, if a baby is given a groundbreaking HIE treatment called hypothermia (brain cooling) treatment, cerebral palsy can be avoided. Hypothermia treatment involves cooling the baby’s core body temperature to a few degrees below normal for 72 hours. Brain cooling treatment must be given within 6 hours of the time the baby experienced the oxygen-depriving insult, which usually means it must be given within 6 hours of birth. Research shows that hypothermia treatment halts almost every injurious process that starts to occur when the brain experiences oxygen deprivation. The treatment can prevent cerebral palsy or reduce the severity of the CP.
Cerebral palsy is a group of disorders that cause a child to have problems with movement, balance and coordination. CP is caused by an injury to the motor centers of the developing brain, which means a child can get cerebral palsy up until approximately age 3, although CP sometimes isn’t recognized until a child is 4 or 5 years of age, when certain developmental milestones are missed. Brain damage causes cerebral palsy by affecting communication between the brain and the muscles.
Spastic cerebral palsy is the most common type of CP, affecting 70 – 90% of all children with cerebral palsy. Spastic CP is a collection of orthopedic and neuromuscular issues that can cause lifelong problems for the child. Spasticity is a condition in which the muscles have an abnormally high muscle tone or stiffness. This muscle tightness causes movement to be difficult and even painful, and the child may have problems with eating, drinking and speaking. The degree of spasticity varies widely from child to child. Some children have problems that are barely noticeable while others have misalignments so pronounced that the child needs crutches to assist in being upright and some children are relegated to a wheelchair.
Above the hips, children with spasticity that only affects the lower body (spastic diplegia) typically retain normal or near-normal muscle tone and range of motion, although some spasticity may affect the upper body. Because leg muscle tightness often leads to instability when in an upright position, extra muscle tension usually develops in the upper body due to the upper body trying to compensate for the instability of the lower body. Without proper therapy and treatment, prolonged spasticity can cause bone, joint and tendon problems, some of which can be very painful for the child.
Award-Winning Birth Injury and Hypoxic Ischemic Encephalopathy Attorneys
If you are seeking the help of a lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost 3 decades.
Birth injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning lawyers are available 24 / 7 to speak with you.