Birth Injury Attorney: Understanding HIE


A birth injury attorney often encounters cases of Hypoxic-ischemic encephalopathy, or HIE, is a serious birth injury often caused by medical malpractice. Up to 60% of infants with HIE have severe disabilities or die by age two.  HIE occurs when a baby experiences limited blood flow and oxygen during fetal development, labor, delivery, or in the postnatal period, resulting in damage to the infant’s brain. The definition of HIE can be understood within the name. Hypoxic means not enough oxygen, ischemic refers to a lack of blood flow, and encephalopathy means brain disorder.

HIE is a broad term that references any type of harm to the baby that fits these circumstances, and as such, has many causes. It may also be referred to as perinatal asphyxia, neonatal encephalopathy, or birth asphyxia. Here’s what you need to know about the condition.

What Causes HIE?

HIE can occur throughout pregnancy and even after delivery, but all of the causes relate to a lack of blood flow and oxygen to the brain. It is often caused by medical malpractice or a doctor’s mistake. During pregnancy, HIE can be caused by:

  • Preeclampsia (maternal high blood pressure)
  • Heart disease
  • Lung malformations
  • Congenital fetal infections
  • Issues with blood flow to the placenta
  • Issues with blood flow to the baby from the placenta
  • Severe fetal anemia
  • Maternal diabetes with vascular disease

Causes of HIE during labor and delivery can include:

  • Abruption of the placenta (when the placenta separates from the uterus prior to birth)
  • Excessive bleeding from the placenta
  • Rupture of the uterus
  • Issues with the umbilical cord
  • Prolonged late stages of labor
  • Abnormal fetal position, including the breech position
  • Maternal low blood pressure
  • Improper fetal heart monitoring
  • Medication problems from Pitocin or Cytotec, which can induce labor but may cause strong and frequent contractions that can deprive the baby of oxygen.

HIE-related post-delivery problems include:

  • Trauma to the brain or skull
  • Serious infections
  • Severe prematurity
  • Severe heart or lung disease
  • Respiratory failure
  • Cardiac arrest
  • Very low blood pressure
  • Jaundice

The Levels of HIE Severity

When a baby is diagnosed with HIE, the doctor also provides a statement of severity level. There are three levels: mild, moderate, and severe.

Stage 1: Mild HIE

In mild cases of HIE, infants may be hyperalert or fussy right after birth. They may also appear floppy, with slightly decreased muscle tone, or they may have brisk deep tendon reflexes, which are the knee-jerk reactions that doctors test for. They may also cry frequently, have difficulty sleeping, or have trouble feeding.

In most cases of mild HIE, the symptoms disappear within 24 hours of birth. Less than 5% of infants with stage one HIE will have a severe handicap, although it’s important that all symptoms are monitored and treated properly before leaving the hospital.

Stage 2: Moderate HIE

With moderate cases of HIE, the baby will have a significant decrease in muscle tone, less reaction to reflex stimulus, difficulty grasping with their hands, and unusual lethargy. They may also have trouble breathing, seizures, a lack of interest in sucking, and Moro Reflex – the sensation of suddenly falling, which can cause them to gasp and reach their arms out.

25% to 75% of infants with moderate HIE will have severe severe disabilities or potentially die early in life. It is incredibly important that the baby is monitored and treated, especially in the first several weeks, as this may significantly improve the baby’s prognosis.

Stage 3: Severe HIE

Babies with severe HIE have an irregular heartbeat with poor blood pressure. They are unresponsive, even to physical stimuli, and appear to be in a coma-like daze. They have depressed deep tendon reflexes, generally floppy muscles, and extreme issues with breathing. They don’t exhibit the normal neonatal reflexes, like sucking, grasping, or swallowing. They also tend to have fixed, unresponsive, or dilated pupils, as well as vision problems. They can also have delayed seizures that increase after 24 to 48 hours and resist treatment.

75% or more of infants in stage 3 HIE will have a severe handicap and could potentially die early in life. In these cases, monitoring and treatment are essential for improving the condition. A doctor may want to order an MRI or other testing to check for damaged brain cells.

Treatment Options for HIE

In all cases of HIE, intervention within the first hours and days after birth is imperative. Proper medical care may improve the baby’s condition significantly, which can reduce any further complications or injuries. Immediate treatment involves therapeutic hypothermia, which cools the baby’s brain down to slightly below normal temperatures for three days after birth. This slows the domino effect that can cause widespread damage with HIE, which is known as reperfusion injury. It also gives the baby’s brain time to recover and slows the metabolic rate.

During this time, the baby is given medication to help them rest. They’re also closely monitored to ensure that they are comfortable. Monitoring is also necessary to ensure that the heart rate, breathing patterns, and temperature remain normal. Hospital staff will perform electroencephalograms (EEGs) to check the baby’s brain activity, as well as use a cerebral function monitor to observe the brain. Since HIE can impact other areas of the body, additional therapies may be needed. This can include a breathing tube if the baby cannot breathe independently, seizure medication, or support for maintaining healthy kidney function, liver function, and healthy blood pressure.

Research shows that treatment is most effective when given within six hours after birth, although it may still be beneficial up to 24 hours later. After the three-day cooling period, the baby is slowly warmed up to normal body temperature. After this point, treatment shifts to adapting to any symptoms that have resulted from the brain injury. This typically includes a wide variety of treatments and a combination of physical, occupational, and medical therapies.

Since hypoxic-ischemic encephalopathy has so many potential causes, it’s important to be aware of the risks factors that exist during pregnancy, delivery, labor, and post-delivery. With this knowledge, you can take action to prevent and, if necessary, properly treat HIE. In the unfortunate case of an accidence, you should seek out a birth injury attorney.

Legal Options: Speak to a Birth Injury Attorney

If your child was injured at birth, it is important to know your rights. Contact us at 800-767-8040 for a free and confidential consultation by a birth injury attorney. You can also contact us by filling out this form:

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