Neonatal Brain Injury: Hypoxic-Ischemic Encephalopathyjury
HIE Lawyers Helping Children in Michigan & All 50 States
A common reason for admission to the NICU is a diagnosis of hypoxic-ischemic encephalopthy (HIE). HIE is a brain injury caused by an insufficient level of oxygenated blood. Synonyms for HIE include birth asphyxia, intrapartum asphyxia, and neonatal encephalopathy.
HIE typically occurs during labor and delivery, when an event or condition interrupts the flow of oxygenated blood to the baby’s brain. This interruption can occur at any point along the pathway that delivers maternal oxygen to the baby (e.g. in the uterus, placenta, or umbilical cord), or within the baby’s body.
HIE can cause permanent brain damage, and result in conditions such as seizure disorders, cerebral palsy (CP), periventricular leukomalacia (PVL) (usually seen in premature infants), intellectual disabilities, developmental delays, hydrocephalus, and other lifelong problems. In a full-term baby, damage to the basal ganglia, cerebral cortex, and/or watershed regions of the brain is typically seen with HIE.
Babies are often admitted to the NICU because they experienced a difficult delivery, and showed concerning signs at birth. These include not breathing or crying, limpness, or an abnormal skin color, abnormal umbilical cord blood gas results, or low Apgar scores. Sometimes babies need to be placed on a breathing machine (ventilator) right away. This is common with premature babies whose lungs aren’t fully developed.
How is Hypoxic-Ischemic Encephalopathy (HIE) Treated?
In the NICU, babies receive very close monitoring. Seizures are common in babies who experienced birth asphyxia and have hypoxic-ischemic encephalopathy, so continuous or frequent EEG monitoring should occur with any baby suspected of suffering an oxygen-depriving insult. Careful monitoring and testing must also take place with these babies because HIE has to be treated within six hours of the oxygen-depriving insult/birth asphyxia. Thus, HIE treatment must usually be administered within six hours of birth.
Treatment for HIE is a fairly recent, groundbreaking therapy called hypothermia (brain cooling) treatment. Hypothermia treatment has been shown to slow down almost every injurious process that starts to occur when the brain suffers an oxygen-depriving insult. It can prevent permanent brain damage and cerebral palsy, or it can decrease the severity of the CP. When receiving hypothermia treatment, a baby is either placed on a cooling blanket or given a cooling cap to wear. The baby’s core body temperature is cooled to a few degrees below normal for 72 hours, and then slowly raised back to normal.
It is crucial that the medical team promptly diagnose HIE in a newborn in order to quickly administer hypothermia treatment and properly manage breathing and blood flow.
What Can Parents Expect When Their Newborn Has Hypoxic-Ischemic Encephalopathy (HIE)?
Newborns with hypoxic-ischemic encephalopathy may be irritable and fussy and may suddenly cry. They may also have difficulty feeding. The baby’s body tone may be either too stiff or too limp and floppy. Signs that a baby may have HIE are listed below.
Signs of HIE may include:
- Low Apgar scores
- An acidic umbilical cord blood gas
- A weak or absent cry at delivery
- An abnormal level of consciousness (overly alert, irritable, lethargic, not very alert)
- Tone and reflex abnormalities, such as hypotonia (baby is limp or floppy) and hypertonia (baby is stiff or spastic)
- Apnea (periods in which the baby stops breathing for 20 seconds or more)
- Feeding difficulties
- Respiratory problems (respiratory depression, apnea) requiring ventilation
- Low blood pressure (hypotension)
- Organ failure
- High or low blood sugar (hyper or hypoglycemia)
What Are The Causes Of Hypoxic-Ischemic Encephalopathy (HIE)?
In the womb, the baby gets oxygen from oxygen-rich blood that travels from the mother to the placenta and on to the baby through the umbilical cord. Anything that affects this pathway can deprive the baby of oxygen. Thus, if the mother is suffering from a lack of oxygen (e.g., she has a major bleed or hemorrhage), the baby will also be deprived of oxygen. More commonly, problems with the umbilical cord, placenta, or womb (uterus) can cause the baby to experience a lack of oxygen in the brain. Often, these issues occur during or near the time of labor.
Problems that can cause a lack of oxygen to the baby’s brain include the following:
- Placental abruption
- Uterine rupture
- Tight nuchal cord (cord wrapped around baby’s neck)
- Umbilical cord prolapse
- Short umbilical cord or cord in a true knot
- Malposition of the baby, such as breech, face, or brow presentation
- Delayed emergency C-section when the baby is in distress
- Post-term pregnancy
- Fetal growth restriction/intrauterine growth restriction (IUGR)
- Premature rupture of membranes (PROM)
- Meconium aspiration
- Severe maternal hypotension (very low blood pressure)
- Preeclampsia and maternal hypertension (high blood pressure)
- Intracranial and intraventricular hemorrhage
- Traumatic delivery, which can occur when forceps or vacuum extractors are used, and may involve shoulder dystocia (shoulder is trapped behind mother’s pelvis)
- Excessively strong and frequent uterine contractions, or hyperstimulation, which can result from improper use of the drugs Pitocin and Cytotec
- Gestational diabetes, especially when accompanied by severe IUGR
- Stroke around the time of birth (perinatal stroke). The majority of babies with ischemic perinatal stroke develop seizures.
How Can Hypoxic-Ischemic Encephalopathy (HIE) Be Prevented?
The most important actions that can be taken to prevent HIE are:
- Recognizing fetal distress on the heart monitor
- Recognizing conditions that can cause significant distress
- Performing a quick C-section delivery when distress or impending distress are evident.
It is the standard of care to continuously monitor the baby’s heart rate when the mother is admitted to the labor and delivery unit. Sometimes, the medical team monitoring the mother and baby are not properly trained in interpreting the fetal heart rate tracings. Other times, there is a breakdown in communication and the physician is not contacted quickly enough, or the physician does not respond fast enough to communications regarding the baby’s distress.
When a baby is in distress, it almost always means that they are suffering from a lack of oxygen in their brain. If the baby’s distress cannot be quickly remedied, the physician must deliver them right away, often by emergency C-section delivery. Indeed, if the distress is severe and a baby cannot be vaginally delivered in a safe and timely fashion, a C-section must quickly be performed. Getting the baby out of the womb is the only way to directly help them and give them oxygen and other critical treatments, such as those given during resuscitation.
Labor and delivery complications such as placental abruption and uterine rupture sound frightening. However, when the baby starts to suffer from birth asphyxia, this will be evident on the fetal heart rate monitor. If the physician delivers the baby right away when distress is first noted, the baby will often be healthy and have no lifelong problems.
Reiter & Walsh: Michigan Hypoxic-Ischemic Encephalopathy (HIE) Lawyers Helping Children Affected by Birth Injuries For Over Three Decades
If you are seeking the help of a Michigan HIE 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 for over three decades.
Partners Jesse Reiter and Rebecca Walsh are currently recognized as some of the best medical malpractice lawyers in America by U.S. News and World Report, which also recognizes 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).
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 firm has many 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. Please reach out today for a free case evaluation.
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