Hypothermic Brain Cooling Attorneys Discuss Treatment for Hypoxic Ischemic Encephalopathy: Neonatal Requirements

Trusted Hypoxic Ischemic Encephalopathy (HIE) Lawyers & Hypothermic Brain Cooling Attorneys

When babies experience a traumatic birth or have difficult stays in the neonatal intensive care unit (NICU), they may experience oxygen deprivation. This type of neonatal injury, which is known as hypoxic ischemic encephalopathy (HIE), is 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 occur when the brain does not receive adequate oxygenation. Currently, the only known treatment for HIE is called hypothermia therapy (also known as body cooling, brain cooling, therapeutic hypothermia, or hypothermia treatment). When hypothermic brain cooling begins within six hours of the oxygen-depriving insult, it slows down nearly every damaging event that starts to occur when the brain is deprived of oxygen. Hypothermia therapy can help decrease the severity of (or even prevent) permanent brain damage that causes debilitating conditions such as cerebral palsy. Research shows that when hypothermia treatment is promptly given after an oxygen-depriving insult, the incidence of death and cerebral palsy is significantly reduced. Therefore, hypothermia treatment is the standard of care when a diagnosis of hypoxic ischemic encephalopathy has been made. The key is for physicians to make the diagnosis soon after the event occurred that caused the baby’s brain to suffer from a lack of oxygen. Throughout this page, our HIE and hypothermic brain cooling attorneys will explain everything you need to know about hypoxic ischemic encephalopathy, hypothermia therapy and birth injury.


Causes of Hypoxic Ischemic Encephalopathy (HIE) and Indications for Hypothermic Brain Cooling

Hypoxic Ischemic Encephalopathy (HIE) Lawyers Discuss HIE Treatment: Brain CoolingHypoxic ischemic encephalopathy (HIE) is caused by a lack of oxygen in the baby’s blood (and brain tissue), called hypoxia, and/or a lack of blood flow in the baby’s brain, called ischemia.  There are many events that can occur during or near the time of birth that can cause a lack of oxygen to the baby’s brain. Sometimes these events occur shortly before birth, when signs of a serious condition affecting the baby are present, but the medical team fails to quickly act and help the baby.  Other times, traumatic events occur during labor and delivery and the baby isn’t delivered quickly enough, which often has to occur by cesarean (C-section) delivery. Then, there are times when the baby is in the NICU and the medical team fails to properly manage the baby’s breathing, causing the baby to have severe oxygen-depriving events and/or long-term (chronic) oxygen deprivation.

During delivery, a baby’s heart rate must be closely monitored by a fetal heart rate monitor. When a baby is experiencing a lack of oxygen to the brain, it will show up on the monitor as an abnormal (non-reassuring) heart tracing. During pregnancy, mothers have regular prenatal testing performed that check the how well the baby is doing, and this includes examination of the baby’s heart rate as well as other conditions that can affect oxygenation and heart rates in the future. These tests are performed to assess factors such as the amniotic fluid and the baby’s response to stimulation.

Conditions that can cause a lack of oxygen to the baby’s brain and hypoxic ischemic encephalopathy (HIE) include the following:

Treatment for Hypoxic Ischemic Encephalopathy (HIE): Neonatal Hypothermic Brain Cooling

Hypoxic Ischemic Encephalopathy (HIE) Lawyers Discuss HIE Treatment: Brain CoolingThe medical team must closely monitor a baby who is at risk for having an oxygen-depriving insult, and this includes the time period during labor and delivery, as well as the time a baby is in the NICU. If there is any possibility that a baby suffered a lack of oxygen in the brain, it is crucial for the medical team to closely monitor the baby for signs of hypoxic ischemic encephalopathy (HIE). The reason this is crucial is because therapeutic hypothermia is not given unless a diagnosis of HIE has officially been made. If a diagnosis is not promptly made, a baby may not receive hypothermia treatment, which means the brain injury may be much more severe than it would have been with the treatment, which can result in the child having cerebral palsy. The more severe the HIE, the sooner the hypothermia therapy must be started, and it must be initiated within six hours* of the oxygen-depriving insult. Indeed, failure to promptly diagnose HIE is medical negligence.

Signs and Symptoms of Hypoxic Ischemic Encephalopathy (HIE)

It is critical for the medical team to closely monitor the baby for signs of hypoxic ischemic encephalopathy so that a quick diagnosis of HIE can be made and hypothermia treatment can be started as soon as possible. As mentioned before, hypothermic brain cooling cannot begin unless a diagnosis of hypoxic ischemic encephalopathy has been made.

Signs and symptoms of hypoxic ischemic encephalopathy:

  • The need for neonatal resuscitation at birth or at any time during the neonatal period could indicate hypoxic ischemic encephalopathy.
  • Low APGAR scores for longer than 5 minutes often indicate that the baby has HIE. An APGAR score assesses the overall health of a newborn over the first few minutes of life. It assigns scores to factors such as the baby’s skin color (complexion(, pulse rate, reflexes, muscle tone and breathing.
  • Seizures within the first 24-48 hours of delivery are one of the most common indicators of HIE caused by an event during birth, and seizures while in the NICU or shortly after discharge from the NICU are an indication of an oxygen depriving insult that occurred after birth. HIE is a leading cause of neonatal seizures.
  • Difficulty feeding, including the inability to latch, suck or swallow, may be a sign of hypoxic ischemic encephalopathy.
  • Profound metabolic or mixed acidemia in an umbilical cord blood sample (the baby’s blood is acidic/has a low pH.) is commonly associated with HIE.
  • Abnormal limpness
  • Multiple organ problems (for instance, involvement of the lungs, liver, heart, intestines) commonly indicates that a hypoxic-ischemic event occurred at or around the time of delivery.
  • Absent brain stem reflexes (for instance, breathing problems and an abnormal response to light, and only blood pressure and heart function reflexes are functioning)
  • Coma in a newborn baby can indicate the presence of hypoxic ischemic encephalopathy.
  • Hypotonia (low muscle tone) commonly indicates that a newborn baby has HIE.

Neonatal Requirements for Therapeutic Hypothermia (Brain Cooling)

Guidelines for therapeutic hypothermia continue to evolve as research progresses, and exact criteria vary from hospital to hospital. However, the Academic Medical Center Patient Safety Organization (AMC PSO) provided the following general recommendations from a task force on neonatal encephalopathy in 2016:

Therapeutic hypothermia should be given when all three of the following criteria are met:

  1. The baby is less than six hours of age*, and was born after at least 36 weeks of pregnancy.
  2. At least one of the following:
    • A complication before delivery, such as cord prolapse, uterine rupture, or profound fetal bradycardia
    • An Apgar score of five or lower at 10 minutes of life
    • Prolonged resuscitation at birth
    • Severe acidosis
    • Abnormal base excess within 60 minutes of birth, as shown in umbilical cord gas or neonate blood gas
  3. At least one of the following:

Additionally, physicians are advised to consider administering therapeutic hypothermia when all three of these criteria are met:

  1. The baby is no more than 12 hours of age*, and was born after at least 34 weeks of pregnancy.
  2. At least one of the following:
    • A complication before delivery, such as cord prolapse, uterine rupture, or profound fetal bradycardia
    • An Apgar score of five or lower at 10 minutes of life
    • Prolonged resuscitation at birth
    • Acidosis
    • Abnormal base excess within 60 minutes of birth, as shown in umbilical cord gas or neonate blood gas
    • A collapse after birth that results in hypoxic-ischemic injury.
  3. At least one of the following:
    • Signs of neonatal seizures
    • Evidence of neonatal encephalopathy in a clinical exam

*Recent research indicates that therapeutic hypothermia may still be beneficial when started up to 24 hours after birth.

When Should A Baby Not Receive Therapeutic Hypothermia?

The AMC PSO guidelines state that babies should not receive hypothermia therapy if they were born very preterm (under 34 weeks into pregnancy), and that physicians should exercise extreme caution if they weigh less than 1,750 grams, have severe congenital abnormalities, suffered major intracranial hemorrhage, have overwhelming septicemia, or show evidence for a blood clotting disorder that could make the treatment dangerous.

Therapeutic Hypothermia - Body Cooling for Babies with Hypoxic-Ischemic Encephalopathy (HIE)


Legal Help for Hypoxic Ischemic Encephalopathy: Hypothermic Brain Cooling Attorneys

If your child underwent therapeutic hypothermia and now has a permanent disability, such as HIE, cerebral palsy, seizures, an intellectual disability or developmental delay, the medical team may have engaged in negligent behavior. If your child has conditions such as HIE or cerebral palsy and hypothermia treatment was not given, this may also be negligent. Sometimes a diagnosis of HIE is made and hypothermia treatment is either improperly given or not given at all. Sometimes hypothermia therapy is properly given but the child still suffers from permanent brain damage. The award-winning hypoxic ischemic encephalopathy (HIE) lawyers at Reiter & Walsh ABC Law Centers have been helping children with birth injuries for decades and have the skill and experience to carefully review medical records to determine if medical malpractice caused a child’s injury.

Birth injury is a difficult area of law to pursue due to the complex nature of the medical records. The award winning hypoxic ischemic encephalopathy (HIE) lawyers at Reiter & Walsh ABC Law Centers have decades of experience with birth injury cases.  To find out if you have a case, contact our nationally recognized Michigan law firm to speak with an experienced attorney.  We handle cases in Michigan, Ohio, Washington, D.C. and throughout the nation.  We have 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 our hypoxic ischemic encephalopathy (HIE) lawyers at 888-419-2229.

In this video, hypoxic ischemic encephalopathy (HIE) lawyers Jesse Reiter and Rebecca Walsh talk about how a lack of oxygen to the brain at or near the time of birth can cause permanent brain injury such as hypoxic ischemic encephalopathy (HIE), seizures and cerebral palsy.


More Information on Hypoxic-Ischemic Encephalopathy (HIE)

More Information on Hypothermia Therapy (Brain Cooling)