$9 Million for a Boy who has Cerebral Palsy from HIE Caused by Mismanaged IUGR & Delayed Delivery
Reiter & Walsh ABC Law Centers obtained a $3.85 million settlement (total annuity payout: $9 million) for a little boy with cerebral palsy who is unable to walk or talk and has to get all his nutrition through a feeding tube. The child’s cerebral palsy was caused by failure to deliver the baby early when the mother had a high-risk pregnancy and the baby had intrauterine growth restriction (IUGR). The delayed delivery caused the baby to have hypoxic ischemic encephalopathy (HIE), which caused seizures and cerebral palsy.
This pregnancy was labeled “high risk” by physicians because the mother had sickle cell disease (SCD) and a brain abscess requiring surgery. The mother also experienced seizures during the pregnancy. SCD increases the risk that a mother will give birth to a baby with a low birth weight. Despite this risk, physicians failed to act on an abnormal Doppler ultrasound at 36 weeks and 2 days of gestation that showed that the baby had intrauterine growth restriction (IUGR) and decreased blood flow going to him from the placenta. IUGR (small baby) means that the baby is having poor growth in the mother’s womb. This poor growth typically occurs when the baby is not getting enough oxygen and nutrients. An ultrasound additionally showed that, although normal, the amniotic fluid was decreased. This can also be an indication of IUGR.
Physicians did not talk to the mother about the abnormal findings; she was not told that her baby had IUGR, nor was she informed that babies with IUGR should be delivered between 34 and 37 weeks of gestation. In fact, the expert who testified on behalf of the mother at trial concluded that the little boy should have been delivered at 36 weeks and 3 days.
The baby was not delivered until 37 weeks of gestation, when the mother was admitted to the hospital because she was experiencing a sickle cell crisis. Thus, the baby was left in oxygen depriving conditions for four days beyond the date the expert said he should have been delivered. To make matters worse, the baby had abnormal (non-reassuring) heart tracings at admission, which is a sign of oxygen deprivation. Physicians did not take appropriate action here either, and delivery did not occur until approximately five hours after the abnormal tracings. Given the high risk pregnancy, IUGR, and non-reassuring fetal heart tracings, the standard of care dictated that prompt action be taken to deliver this little boy right after the mother was admitted to the hospital. It was later discovered that at admission, physicians overestimated the baby’s weight by 1,000 grams. The little boy was so small that his weight was less than the 1st percentile of babies at similar age. He weighed just over 1900 grams (4.2 lbs) at birth.
Unfortunately, this tiny boy was born with very low Apgar scores, an indication that he would need medical attention. In addition, his umbilical cord blood was acidic, which means he was being deprived of oxygen in the womb. Shortly after birth he began having seizures, and images taken of his brain were abnormal, indicating brain damage. The little boy was diagnosed with hypoxic ischemic encephalopathy (HIE / birth asphyxia), and he was given brain cooling (hypothermia) treatment in an attempt to slow down or prevent further brain injury. Despite the treatment, he was later diagnosed with spastic quadriplegic cerebral palsy and profound developmental delays.
Defendants argued that the HIE occurred 1 – 4 days after birth, and that a brain bleed (hemorrhage) caused the HIE. Defendants further argued that the ultrasounds that indicated that the baby had IUGR did not warrant delivery. The defense also claimed that when the mother was admitted for her sickle cell crisis, a five hour delay in delivery was proper because the delivery occurred when fetal monitoring became concerning.
SICKLE CELL DISEASE, OXYGEN DEPRIVATION AND HIE
Expectant mothers with SCD are at risk of their babies experiencing oxygen deprivation because SCD can cause restricted blood flow in the placenta. In addition, the increased oxygen and nutrient consumption that occurs when SCD is present also can cause a reduction in oxygenation (and nutrition). Due to the potential oxygen (and nutrient) deprivation in babies of mothers with SCD, the standard of care requires more frequent prenatal testing and that physicians pay very close attention to signs of IUGR and decreased well-being of the baby. Failure to take appropriate action when a baby has IUGR and is receiving decreased blood flow and oxygen can cause the baby to have HIE. HIE is a form of brain damage caused by decreased oxygen in the blood going to the baby and / or decreased flow of blood going to the baby.
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