Hypoxic Ischemic Encephalopathy (HIE) Information Resources
Medical Information | Hypoxic Ischemic Encephalopathy (HIE)
Welcome to the Reiter & Walsh, P.C. HIE Help Center
At Reiter & Walsh ABC Law Centers, we understand how overwhelming a diagnosis of hypoxic ischemic encephalopathy (HIE) can be. Families are often left without important answers regarding the cause of their child’s birth injury, the resources available for rehabilitation, and the funds necessary to ensure their child’s well-being. Adapting to a new lifestyle with a child with HIE takes extraordinary time and effort. Our goal at the HIE Help Center is to provide you with information that will serve as a preliminary support system while your case is being pursued. We will explain hypoxic ischemic encephalopathy (HIE), provide details about your legal options and point you in the direction of valuable HIE and disability resources.
What Is Hypoxic Ischemic Encephalopathy (HIE)?
HIE, also commonly known as birth asphyxia or neonatal encephalopathy (NE), is a dangerous type of neonatal brain injury caused by oxygen deprivation and limited blood flow to the baby’s brain at or near the time of birth. Cell death and subsequent brain damage occurs when the brain does not receive adequate oxygenation. With proper management in a hospital setting, HIE is almost always preventable. In order to understand HIE more fully, it is helpful to dissect the term itself:
- Hypoxic refers to hypoxia, or a shortage of oxygen in the blood.
- Ischemic refers to ischemia, or a shortage of blood flow to the brain.
- Encephalopathy refers to the resulting brain damage.
Occurring in roughly 2-9 per 1,000 live births, HIE is a form of birth trauma that causes significant and permanent infant brain damage, lifelong disabilities, seizure disorders and epilepsy, motor function delays, intellectual impairments, cerebral palsy, neurodevelopmental impairments and even death. HIE is one of the most common causes of birth injuries and severe pediatric impairments and disabilities.
- Asphyxia: An emergency condition characterized by severe oxygen deprivation—particularly in the womb—causing death, disability or permanent injury.
- Neonatal Encephalopathy (NE): A broad term used to describe disturbed neurological function in a newborn baby. Some signs and symptoms of disturbed neurological function in a newborn infant may include respiratory distress, feeding problems, depressed reflexes, low or high muscle tone (stiff or floppy appearance) and/or seizure activity. Hypoxic ischemic encephalopathy (HIE) is the most common type of neonatal encephalopathy.
- Birth Asphyxia: A lack of oxygen flow to the brain before, during or directly after birth. Birth asphyxia is very dangerous and can lead to neonatal encephalopathy (NE) and hypoxic ischemic encephalopathy (HIE). Birth asphyxia is another term for intrapartum asphyxia.
- Intrapartum Asphyxia (Intrauterine Asphyxia): A lack of oxygen flow to the brain before, during or directly after birth. Birth asphyxia is very dangerous and can lead to neonatal encephalopathy (NE) and hypoxic ischemic encephalopathy (HIE). Intrapartum asphyxia is another term for birth asphyxia.
Classification of HIE Based on Severity
Fetal oxygen deprivation occurs in varying degrees of severity. In this section, we’ll discuss the three main groups used to classify and describe the severity of hypoxic ischemic injuries.
- Acute Profound Asphyxia: Acute profound asphyxia is the most severe form of hypoxic ischemic injuries. Commonly referred to as acute near total asphyxia, this form of hypoxic ischemic encephalopathy is caused by longer, more complete periods of fetal oxygen deprivation. Known causes of acute profound asphyxia include emergency pregnancy, labor and delivery complications such as uterine rupture, umbilical cord prolapse, placental abruption and terminal bradycardia.
- Partial Prolonged Asphyxia: When partial prolonged asphyxia occurs, the baby generally suffers oxygen deprivation for around 30 minutes. Neonates can withstand oxygen deprivation for short amounts of time. However, neonatal brain damage associated with this longer form of birth asphyxia is severe and serious. Known causes for partial prolonged asphyxia include oligohydramnios, preeclampsia and hypertension, hypotension, strong contractions and uterine hyperstimulation, placental insufficiency, umbilical cord prolapse, umbilical cord compression, short umbilical cord length and nuchal cords.
- Mixed Injury Pattern Asphyxia: When a neonate experiences oxygen deprivation patterns characteristic of both acute profound asphyxia and partial prolonged asphyxia, the type of HIE is classified as mixed injury pattern asphyxia. Mixed injury pattern asphyxia can occur before, during or after delivery.
Signs and Symptoms of HIE
Before discussing more detailed information about the signs and symptoms of HIE, it is important to understand the difference between signs and symptoms. Although signs and symptoms are often used interchangeably, they have distinct definitions:
- Signs can be detected, measured and confirmed in clinical settings. For example, seizures and organ failure are signs of HIE.
- Symptoms are solely based on a patient’s personal experience of his or her medical conditions. Since newborns cannot express their experiences of medical conditions in words, HIE diagnoses are typically based off clinical signs instead of symptoms.
Clinical signs indicating HIE may include:
- Low Apgar scores
- Weak or absent cry immediately after delivery
- The need for infant resuscitation during the neonatal period
- Seizures within the first 24 to 48 hours of life
- Acidic blood, indicating profound metabolic or mixed acidemia
- Abnormal levels of consciousness
- Absence of brainstem reflexes
- Tone and reflex abnormalities, including hypotonia (baby is limp or floppy) and hypertonia (baby is stiff or spastic)
- Apnea (periods when the baby stops breathing for 20 seconds or more)
- Feeding difficulties
- Stiffness of the neck, indicating the baby has meningitis or meningoencephalitis
- Organ failure or organ problems
- Hyperglycemia or hypoglycemia
Clinical signs for HIE are readily seen by risk factors or abnormalities on the fetal monitor. Symptoms are often not a factor aiding in the diagnosis of HIE because newborns cannot yet use the language or expressions necessary to indicate their symptoms. Many children with HIE do not show signs or express symptoms until they are older. In order to detect signs of HIE, it is critical for medical personnel to thoroughly evaluate a newborn, particularly if an oxygen depriving event occurred. Additionally, family members, friends, teachers, caretakers or other people close to young children should closely monitor their behaviors and developmental milestones.
Causes and Risk Factors for HIE
The permanent brain damage associated with hypoxic ischemic encephalopathy (HIE) can result from a wide range of mishandled pregnancy, labor, delivery and neonatal problems. Whenever a medical professional fails to diagnose, treat, prevent, or manage a certain cause or risk factors for HIE and the result is an injury to the mother or baby, it is medical malpractice. In these situations, the parent or guardian is eligible to pursue a medical malpractice lawsuit in order to obtain compensation for him/herself and the child.
One of the most common causes of HIE is the failure to deliver a baby experiencing fetal oxygen deprivation in a timely manner. This is also one of the most common areas of medical malpractice involved in labor and delivery. Below is a list of several causes and risk factors for HIE. Each of the following complications, injuries, medical mistakes and scenarios compromise the flow of oxygenated blood to the baby’s brain.
- C-section mistakes:
- Delayed C-section
- Delayed emergency C-section
- Failure to perform C-section
- Intracranial hemorrhages (brain bleeds)
- Tachysystole (excessive uterine contractions)
- Prolonged and arrested labor
- Misuse of the labor induction drugs Pitocin and Cytotec
- Misuse of delivery assistance tools, including vacuum extractors and forceps
- Uterine rupture
- Placental abruption
- Placenta previa
- Mismanaged uteroplacental insufficiency
- Problems related to fetal size:
- Cephalopelvic disproportion (CPD)
- Problems related to fetal presentation and position:
- Face presentation
- Breech presentation
- Umbilical cord complications:
- Nuchal cord
- True knot
- Umbilical cord prolapse
- Umbilical cord compression
- Short cord length
- Preeclampsia (maternal high blood pressure)
- Post-term pregnancy
- Premature birth
- Premature rupture of membranes (PROM or PPROM)
- Anesthesia mistakes
- Fetal stroke
- Improper management of neonatal respiration
- Fetal monitoring errors
- Improper management of neonatal infection
- Improper management of anemia
- Chorioamnionitis and villitis
- Meconium aspiration
What Instances of Medical Malpractice Can Cause HIE?
Standards of medical care require physicians, nurses, midwives and all other medical professionals to quickly and thoroughly diagnose, manage, treat and prevent any of the many possible causes and risk factors for HIE. However, instances of medical malpractice occur every year and thousands of newborns experience HIE. Below, we’ll list some instances of medical malpractice that cause fetal oxygen deprivation and HIE.
Instances of medical malpractice causing HIE include, but are not limited to, the following:
- Medical professionals inaccurately read fetal distress signs on a fetal heart monitor, thereby failing to detect fetal oxygen deprivation
- Medical professionals fail to timely deliver babies to avoid birth injuries
- Medical professionals fail to detect, diagnose, treat, or manage a condition or complication that leads to hypoxic ischemic encephalopathy
- Medical professionals fail to offer and/or perform hypothermia treatment on a qualifying newborn with hypoxic ischemic encephalopathy
- Medical professionals mishandle neonatal respiration (ventilation) after delivery
- Medical professional over- or under-administer anesthesia during labor and delivery
- Medical professionals misuse forceps or vacuum extractors (labor and delivery assistance devices)
- Medical professionals allow for the vaginal delivery of a baby that, due to risk factors, should have been delivered via C-section
In most cases, the diagnostic process for hypoxic ischemic encephalopathy begins once a medical professional notices one or more of the aforementioned clinical signs for HIE. Some factors that may prompt physicians to test include traumatic delivery, organ dysfunction, seizures within 24 hours of birth, or other present risk factors. Birth asphyxia diagnoses typically combine maternal-fetal history, laboratory testing, and physical and neurological examinations. Most diagnostic tests are completed in order to test brain functioning and assess how extreme the brain injury is. Once medical professionals suspect hypoxic ischemic encephalopathy occurred, diagnostic and neuroimaging tests are done to confirm the diagnosis. These may include the following:
- PET scans
- CT scans
- Blood glucose tests
- Arterial blood gas tests
It is critical that medical professionals diagnose HIE promptly. The sooner a baby is diagnosed with HIE, the sooner treatment and therapy measures can begin. In order to receive hypothermia treatment, the only known treatment for HIE currently, the baby must be diagnosed with HIE within six hours of the oxygen depriving insult. In many cases, unfortunately, signs and symptoms of hypoxic ischemic encephalopathy do not appear until later in the child’s development when he or she misses developmental milestones. In many of these cases, medical professionals fail to recognize early signs of HIE in a baby, thereby failing to perform hypothermia treatment. For this reason, a number of babies are not diagnosed with HIE in the neonatal period.
Side Effects of HIE
The effects of hypoxic ischemic encephalopathy depend on the severity of the oxygen-depriving insult, so individuals with HIE often experience varying side effects ranging from mild to severe. Medical professionals must take every precaution to prevent hypoxic ischemic events and, when HIE occurs, perform hypothermia treatment under the required indications. The following injuries, complications and lifelong disabilities are known to occur as a result of hypoxic ischemic encephalopathy:
- Cerebral palsy (CP)
- Intellectual and Developmental Delays (I/DD)
- Movement disorders
- Seizure disorders and epilepsy
- Speech, communication and swallowing disorders including apraxia, dysphagia, oral aversion and speech delays
- Kidney and renal disorders
- Fine motor delays
- Gross motor delays
- Neurodevelopmental delays
- Respiratory system problems
- Endocrine system problems
- Urinary and digestive system problems
- Skeletal and musculoskeletal system problems
- Visual impairment
- Hearing impairment
- Fetal death
Treatment and Therapy for HIE
Treatment for HIE
In the past, treatment of HIE solely included supportive care that focuses on preventing further brain damage. This meant lengthy NICU stays, mechanical ventilation, seizure management, blood glucose management, blood pressure maintenance and minimizing brain swelling.
Today, hypothermia treatment is the only procedure known to treat HIE. Also known as brain cooling, hypothermia treatment improves the health outcomes of babies with HIE by halting the progression of brain damage, thereby reducing the severity and permanence of brain injury. The treatment consists of lowering a newborn’s body temperature to around 91 degrees Fahrenheit for a period of about 72 hours. By lowering the baby’s temperature, the metabolic rate is slowed to allow cells to recover over a longer period of time. Without hypothermia treatment, normal oxygenation or blood flow is restored too quickly to injured cells, ultimately progressing the brain injury.
Before receiving hypothermia treatment, babies must meet some important prerequisite conditions:
- The oxygen-depriving insult must have taken place within six hours of the onset of hypothermia treatment
- The baby must have reached at least 36 weeks of gestation
- No contraindications for hypothermia treatment can be present
Therapy for HIE
Because infants that suffer a hypoxic ischemic event at birth typically go on to live with permanent brain damage and disabilities, they are encouraged to take part in a variety of rehabilitation programs, medical procedures and lifestyle adjustments. The following therapeutic methods can help people with HIE improve functional ability and adjust to limitations:
- Physical therapy
- Occupational therapy
- Speech-language therapy
- Stem cell therapy
- Recreational therapy
- Special education
- Alternative and complementary therapy
- Animal-assisted therapy
- Suit therapy
- The use of adaptive equipment and assistive technology
Therapy plans are based on the individual’s personal rehabilitation needs and generally encompass one or more therapy techniques. Additionally, certain surgeries and medications may help with residual impairments from a hypoxic ischemic encephalopathy diagnosis.
Hypoxic ischemic encephalopathy (HIE) is largely a preventable birth injury. Since fetal oxygen deprivation and HIE are commonly the result of medical errors made at birth or around the time of delivery, preventing it often comes down to providing careful, quality obstetrical care. Because the permanent disabilities and injuries caused by HIE are so extreme, it’s critical that medical professionals follow all care standards in order to prevent fetal oxygen deprivation. Throughout this section, we’ll cover some of the basics surrounding birth injury and HIE prevention.
How Medical Professionals Must Prevent HIE
According to standards of medical care, it is the responsibility of all medical personnel to prevent HIE and birth injuries. This means that doctors, anesthesiologists, nurses, midwives, pharmacists, hospital staff and all other medical professionals interacting with an expectant mother and her baby must:
- Prevent HIE and any of its causes or risk factors to the best of their ability
- Properly manage any present causes or risk factors for HIE
- Treat any causes or risk factors for HIE
- Detect and diagnose HIE if it is present
- Perform hypothermia treatment (brain cooling) for babies with HIE unless contraindications are present
- Performing all other medical duties necessary to prevent and/or handle HIE
Preventative Procedures for HIE
We’ve discussed how the general management, prevention, diagnosis and treatment of the various causes and risk factors for HIE can help prevent the dangerous injury. In this section, we’ll specifically list some of the most common ways to prevent HIE. Some of these may include the following:
- Performing elective C-section deliveries at 39 gestational weeks or sooner for certain high-risk pregnancies
- Performing and planning C-section deliveries for those pregnancies with risk factors for HIE (such as in cases of cephalopelvic disproportion).
- Properly interpreting fetal heart tracings to ensure the baby is not in distress around the time of delivery
- Preventing prolonged labor and delivery
- Swiftly performing emergency C-sections when dangerous causes or risk factors for HIE present themselves during vaginal delivery
- Performing hypothermia treatment in newborn babies with HIE to halt the progression of brain injury
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Begin Your Legal Consultation with Our Michigan HIE Attorneys
We encourage you to contact our Detroit, Michigan HIE attorneys with any legal questions, concerns, or case inquiries you may have. If your loved one was diagnosed with HIE or another permanent injury or disability from medical malpractice, you and your family may be entitled to compensation.
At Reiter & Walsh, P.C., we solely handle birth injury and birth trauma cases. Our attorneys specifically focus on HIE, cerebral palsy and birth injury cases, giving our team the depth of knowledge and experience necessary to win complicated, multi-million dollar cases.
To begin your free case review, please contact a Michigan HIE attorney from our legal team in whichever way best suits your needs. Our HIE attorneys serve clients across the United States. Should we take your case, you will never be charged until we win or settle in your favor.
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