Hypoxic Ischemic Encephalopathy

brain injury in baby

Hypoxic ischemic encephalopathy (HIE) is a birth injury that may occur as a result of medical malpractice.  Like most birth injuries, it is caused by a lack of oxygen to the brain.  (Hypoxia means lack of oxygen reaching the tissue.  Ischemia means inadequate blood supply to an organ or part of the body.  Encephalopathy means the brain is affected.)

Babies are designed to withstand the normal trauma of child birth, such as minor cord compression during contractions.  But when a baby is partially or totally deprived of oxygen for an extended period of time, brain cells are injured and destroyed.

HIE can cause conditions such as cerebral palsy, epilepsy, motor impairment, developmental delay, cognitive impairment and death.  The injury and associated impairments depend on where the injury occurred.  For example,  Injuries to the cerebrum can cause learning disabilities or difficulty with higher functions.  Injuries to the cerebellum can result in motor difficulties or weakness.

HIE Risk Factors

There are several risk factors for HIE.  When these factors are present and known to physicians, they should be on high-alert and take precautions to avoid HIE.  Here are the most common risk factors:

  • Nuchal cord (i.e., cord wrapped around baby’s neck)

  • Cord prolapse (i.e., umbilical cord is delivered before the baby)

  • Short cord

  • Infection

  • Placental abruption

  • Stress of prolonged and complicated labor and delivery

  • Uterine rupture

  • Fetal stroke

  • Vasa previa

  • Placenta previa

  • Intraunerine Growth Restriction

  • Labor and Delivery Errors such as:

    • Failing to prevent preterm birth​

    • Failing to act promptly to a premature rupture of membranes

    • Failing to induce delivery after 40 weeks

    • Failing to convert to a C-section in the face of prolonged or stalled labor

    • Failing to avoid a traumatic birth

    • Failing to perform a C-section instead of vaginal delivery when there are risk factors for shoulder dystocia

    • Failing to take appropriate measures to resolve a shoulder dystocia

    • Failing to properly resuscitate or ventilate a newborn after a difficult or traumatic birth

    • Improper neonatal complication management

Severity of Injuries and Signs / Symptoms

The degree of brain injury varies from minor to severe to fatal.  Generally, the longer and more severe the oxygen deprivation, the worse the brain injury.  Damage will be worse if the baby is not properly resuscitated or treated after delivery.  However, the full extent of the injury in survivors will generally not be known until the child is school age.  Symptoms vary depending on the location of the brain injury and the severity, but can include:​

  • Hypotonia (i.e., poor muscle tone)

  • Bluish skin, lips or extremities at birth

  • Seizures

  • Poor feeding

  • Depressed level of consciousness

  • Metabolic acidosis

  • Coma

  • Lack of reflexes

  • Low APGAR scores

  • Speech delays

  • Developmental delays

  • Cerebral palsy

  • Cognitive disabilities

  • Microcephaly

  • Learning disabilities

Babies with mild HIE can do well.  Sadly, though, babies with moderate to severe HIE may need lifelong medical care, monitoring, therapy and home-based assistance.

Treatment Options

Brain damage caused by HIE is permanent.  However, treatment can be initiated to stop further damage from occurring.  This includes prompt resuscitation and stabilization. It can also include therapeutic hypothermia (cooling of the baby’s brain or body), medication to control seizures, correction of metabolic acidosis, and heart and blood pressure medications.

Babies who suffered HIE at birth should be closely monitored as they develop so that delays and impairments can be promptly identified.  Early intervention is key.  

We Can Help

If your labor and delivery was complicated, and your child suffered HIE at birth, it is important to explore his or her legal rights and see if there is a valid medical malpractice claim.  Birth injury litigation can be complex; we have a network of professionals, from medical experts to financial experts.  Please contact Hoffer & Sheremet, PLC at 616.278.0888 to learn more about compensation to which your child may be entitled, or fill out our Free Consultation Form here