Michigan HIE Lawyers Helping Children with Birth Injuries from Medical Malpractice
The Michigan HIE lawyers at Reiter & Walsh ABC Law Centers have helped hundreds of children affected by hypoxic ischemic encephalopathy (HIE) and birth injuries. Michigan HIE 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).
The Michigan HIE lawyers at Reiter & Walsh have a centrally located office in Bloomfield Hills, Michigan but travel all over the state and around the country to meet with the families they help. Our award winning Michigan HIE lawyers give personal attention to each child and family they help so they can fully understand the child’s lifelong needs. If your child has hypoxic ischemic encephalopathy (HIE), cerebral palsy, seizures, developmental delays or any other birth injury, contact the Michigan HIE lawyers at Reiter & Walsh today. Our attorneys are available 24 / 7 to speak with you and no fees are paid to our firm until we win your case. Call us today at 888-419-2229.
Michigan HIE Lawyers Answer a Frequently Asked Question: What is Hypoxic Ischemic Encephalopathy (HIE) and What Are the Long-term Effects of HIE?
Hypoxic ischemic encephalopathy (HIE) is a brain injury caused by a lack of oxygen-rich blood in the baby’s brain. HIE is often caused by problems that occur during or near the time of birth, such as a placental abruption or the umbilical cord being wrapped around the baby’s neck (nuchal cord). If a baby isn’t delivered quickly enough when she is experiencing birth asphyxia, brain injury in the form of hypoxic ischemic encephalopathy (HIE) can occur.
HIE can be treated by hypothermia (brain cooling) treatment, but the cooling must be started within 6 hours of the time the birth asphyxia occurred, which means the treatment must usually be initiated soon after delivery. Treatment helps some babies avoid permanent brain damage. For many babies, however, hypoxic ischemic encephalopathy causes long-term problems and conditions such as the following:
- Permanent brain damage
- Cerebral palsy (CP)
- Seizure disorders
- Intellectual disabilities
- Developmental delays
- Motor disorders
- Periventricular leukomalacia (PVL). HIE usually involves damage to the basal ganglia, cerebral cortex and watershed regions of the brain, but sometimes also includes PVL.
Michigan HIE Lawyers Discuss the Causes of Birth Asphyxia
Birth asphyxia occurs when a baby experiences an insufficient level of oxygen during or near the time of birth. Birth asphyxia is usually caused by a decrease in blood flow in the uterus, placenta and/or the umbilical cord. An unborn baby is completely dependent upon the mother for oxygen. Oxygen-rich blood travels from the mother’s circulatory system through vessels that run through the uterus and placenta. The blood then enters the umbilical cord vein where it travels to the baby and becomes part of the baby’s circulatory system.
The following is a list of conditions that can cause birth asphyxia if not properly managed. These conditions usually occur during or near the time of delivery.
- Failure to quickly deliver the baby when oxygen deprivation (fetal distress) is evident on the heart rate monitor (delayed emergency C-section).
- Umbilical cord problems, such as a prolapsed umbilical cord, the cord being wrapped around the baby’s neck (nuchal cord), a short umbilical cord, and the cord being in a true knot can all cause severe oxygen deprivation in the baby due to cord compression. A short umbilical cord is dangerous because any movement of the baby can pull on the cord’s insertion point on the placenta, causing the placenta to tear away from the womb (placental abruption).
- Placental abruption. This is where an organ crucial in delivering oxygen-rich blood to the baby – the placenta – separates from the wall of the uterus. Abruption can cause severe bleeding and loss of oxygen to the baby.
- Uterine rupture. This occurs when there is a tear through all the layers of the womb. A ruptured uterus can cause severe hemorrhaging in the mother and the baby can spill out of the womb and into the mother’s abdomen. The hemorrhaging can cause the mother to lose so much blood that there is a decreased flow of blood to the baby, or the rupture may be at a spot that affects the blood circulation between the uterus and placenta.
- Uteroplacental insufficiency / placental insufficiency. When vessels in the uteroplacental circulation are abnormal or compromised, the baby may experience long-term oxygen deprivation. Uteroplacental insufficiency can cause intrauterine growth restriction (IUGR) / fetal growth restriction (FGR).
- Preeclampsia. This is when the mother has high blood pressure diagnosed during pregnancy, which can cause a decreased flow of blood to the baby and other serious problems, including eclampsia.
- Placenta previa. This is when the placenta grows close to the opening of the uterus, which can partially or completely block the mother’s cervix, which is the opening to the birth canal.
- Fetal stroke. A fetal stroke occurs when blood vessels in the baby’s brain become blocked or restricted. Forceps and vacuum extractors can cause the baby to have a stroke, which can cause severe oxygen deprivation. Hypoxic ischemic encephalopathy (HIE) and stroke often occur together.
- Premature rupture of the membranes (PROM). PROM occurs when the water breaks before the mother goes into labor. PROM can cause umbilical cord compression, premature birth and being born before the lungs are fully developed, which can cause a lack of oxygen to the baby’s brain.
- Prolonged and arrested labor. Contractions during labor are traumatic for the baby, and when labor is prolonged, there can be a lack of oxygen to the baby’s brain that gets progressively worse, especially if Pitocin or Cytotec are used.
- Oligohydramnios (low amniotic fluid). This is a condition in which the mother has low amniotic fluid. Oligohydramnios puts the baby at significant risk of having a prolapsed or compressed umbilical cord. Oligohydramnios can also lead to meconium aspiration, which can cause respiratory distress and oxygenation problems.
- Abnormal presentations. When a baby is not in the normal, head first position at the time of delivery, she is at risk of suffering head trauma, brain bleeds and umbilical cord problems if the doctor attempts vaginal delivery. Breech presentation, transverse lie position and face presentation are some of the abnormal positions that increase a baby’s risk of suffering bleeds and cord problems. Research shows that a C-section delivery is the safest way to deliver a baby in breech presentation.
- Anesthesia mistakes, which can cause blood pressure problems – especially low blood pressure – in the mother, including a hypotensive crisis. When a mother’s blood pressure drops too low, there will be a decreased supply of oxygen-rich blood going to the baby.
- 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 cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia also put a child at risk of having a brain bleed.
Michigan HIE Lawyers Explain How Birth Asphyxia Causes Hypoxic Ischemic Encephalopathy
The degree of brain injury a baby experiences when birth asphyxia occurs depends on the severity of the birth asphyxia, how long the asphyxia lasts, the baby’s age and reserves (fetal reserves), and medical management of the baby during and after birth. When a baby is experiencing birth asphyxia, the fetal heart rate monitor will show nonreassuring heart tracings. When these tracings occur, the medical team usually performs resuscitative maneuvers – such as giving the mother IV fluids and oxygen – designed to increase blood flow and oxygenation to the baby. However, while these interventions are taking place, preparations for a prompt C-section delivery should be made. A C-section delivery is usually the fastest and safest way to deliver a baby who is experiencing birth asphyxia. Indeed, it is crucial to quickly deliver a baby who is in distress so that oxygen deprivation is minimized. The sooner the baby is delivered, the sooner the medical team can directly help her.
When birth asphyxia occurs, the baby becomes hypoxic (has insufficient oxygen) and usually hypercarbic (has high carbon dioxide in the blood). Hypoxia causes anaerobic metabolism and lactic acid production. When a lot of acid builds up in the baby’s blood, it is called acidosis. Acidosis and hypoxia can cause decreased heart function, which can cause the baby to have very low blood pressure hypotension and decreased blood flow in the brain. Hypoxia causes ischemia and ischemia causes hypoxia. Indeed, when birth asphyxia occurs, ischemia further impairs oxygen delivery to the baby. Hypoxia and ischemia cause a cascade of events that disrupt energy pathways. Prolonged birth asphyxia causes the baby to have a hypoxic-ischemic state, which causes the brain to be deprived of glucose and all other nutrients, as well as oxygen. In addition, the process of waste-removal is disrupted, which causes more problems. Typically, the longer a hypoxic-ischemic state continues, the more injury there will be to the brain.
If a hypoxic-ischemic event is severe enough to damage the brain, the baby will usually develop hypoxic ischemic encephalopathy (HIE) by 12 – 36 hours. A baby with HIE may have the following symptoms:
- Seizures, especially within the first 24 – 48 hours of life
- Hypotonia (baby is floppy / limp)
- Poor feeding
- Depressed level of consciousness
- Multiple organ problems (involvement of the lungs, liver, heart, intestines, etc.)
- No brain stem reflexes (breathing problems, an abnormal response to light, and only blood pressure and heart reflexes are functioning)
At birth, babies with HIE may also have experienced the following:
- Had an acidic umbilical cord blood gas
- Had to be resuscitated at birth
- Had a low Apgar score for longer than 5 minutes
When a baby experiences severe or total birth asphyxia, also called acute profound asphyxia, the part of the brain injured is typically the deep gray matter. When asphyxia is abrupt and severe (acute near total), deep structures are usually damaged. These include the basal ganglia, thalamus and brain stem. When the baby experiences asphyxia that is moderate to severe and relatively prolonged (acute profound), injury will usually be seen in the cerebral cortex as well as the deep brain structures, particularly the thalami, hippocampi, putamen and dorsal part of the midbrain.
If the asphyxia is partial and prolonged (usually lasting for more than 30 minutes), there will mainly be cortical injury in the watershed and parasagittal regions of the brain, which are areas that do not have direct arterial blood supply.
Babies can also experience partial prolonged asphyxia as well as acute profound asphyxia, which causes a mixed brain injury pattern. The more severe the birth asphyxia and resultant hypoxic ischemic encephalopathy (HIE), the sooner hypothermia treatment should be given.
Michigan HIE Lawyers Discuss How Hypoxic Ischemic Brain Injury is an Ongoing Process
Hypoxic ischemic encephalopathy (HIE) is an evolving process. In addition to the first set of injurious events that start to occur when there is a hypoxic-ischemic insult, there is also a delayed cascade of molecular events triggered by the initial insult. For example, MRI studies show that the size of abnormal (injured) tissue increases over the first few days after injury. Within the first few hours after a baby experiences near total asphyxia, findings on MRI are usually subtle and are often only seen on a specific type of MRI called diffusion weighted imaging. This type of imaging typically shows initial small lesions in the putamen and thalami that usually progress over the next 3 – 4 days to involve more extensive regions of the baby’s brain.
Research shows that during this period of days after the initial oxygen-depriving insult, many neurons and other cells are programmed to die or survive over a period of days to weeks. Research has also helped scientists understand the progression of energy failure in the cell, as well as the severe cell swelling and accumulation of intracellular calcium that cause cell death. Indeed, a hypoxic-ischemic brain injury can progress over days and weeks, which is why it is important for the a medical team to perform regular brain imaging studies on a baby with encephalopathy. Of course, sometimes even the best radiologists miss evidence of brain injury on a scan, and there are instances in which brain injury exists but is not evident.
Edema, which is swelling caused by too much fluid in the babies brain, is a consequence of hypoxic ischemic encephalopathy. When a brain scan shows that a baby has edema within the first day or so after birth, it typically means that the baby experienced a brain insult during or near the time of delivery.
Michigan HIE Lawyers Discuss the Importance of Hypothermia Treatment for HIE
Hypothermia treatment for HIE has been shown to halt almost every injurious process that starts to occur when the brain experiences an oxygen-depriving insult. Scientists think that one of key reasons this treatment protects the brain is because it stops the signaling events inside the cells that initiate a cell death cascade. Hypothermia treatment can minimize the extent of permanent brain injury in a baby who has HIE. This treatment can help prevent a baby with HIE from developing cerebral palsy, or the baby may have a less severe form of CP.
Most hospitals have methods in place to quickly assess a baby’s eligibility for hypothermia treatment.
Award-Winning Michigan HIE Lawyers Helping Children for Nearly 30 Years
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.
Michigan HIE 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 being one of the best medical malpractice law firms in the nation.
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning Michigan HIE 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 law 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 Michigan HIE lawyers are available 24 / 7 to speak with you.
Video: Michigan HIE Lawyers Discuss Birth Asphyxia
Watch a video of Michigan HIE lawyers Jesse Reiter and Rebecca Walsh discussing the causes of birth asphyxia and HIE.