Harris Powers & Cunningham HPC Law Offices

Harris Powers & Cunningham

Serious Injury & Wrongful Death Attorneys

Hypoxic-Ischemic Encephalopathy Attorneys

Was Your Child Diagnosed with HIE in Arizona?

If your child has been diagnosed with Hypoxic Ischemic Encephalopathy (HIE) it may be due to a birth related injury and you may have a claim for legal restitution. Medical errors or negligence often cause HIE.

What is Hypoxic Ischemic Encephalopathy (HIE)?

Hypoxic Ischemic Encephalopathy is caused by an insufficient amount of oxygenated blood flow to the baby’s brain. Hypoxic means not enough oxygen; ischemic means not enough blood flow; and encephalopathy means brain disorder. HIE is also sometimes described as birth asphyxia, perinatal asphyxia, and neonatal encephalopathy.

Infograph: what is hypoxic ischemic encephalopathy

 

The lack of oxygen at birth can lead to severe, permanent injuries for the newly born.

Causes of Birth Asphyxia and HIE

Various contributing factors that may occur before, during or after delivery; or in the postnatal period.

During pregnancy, certain conditions may make a baby more susceptible to suffering HIE. Due to the baby’s higher susceptibility to HIE, Healthcare providers should adjust their care accordingly. Conditions that may make babies more susceptible during pregnancy include:

  • Diabetes
    • Diabetes and gestational diabetes, which is when a pregnant woman is diagnosed with diabetes for the first-time part-way through pregnancy, may lead to an enlarged fetus, or macrosomia, which, in turn, increases the risk for HIE.
  • Preeclampsia
    • Preeclampsia is a serious condition that causes elevated blood pressure levels in the mother. These elevated blood pressure levels may affect the blood supply to the placenta which increase the risk for HIE.
  • Fetal Infections
    • Fetal infections generally occur as a result of the mother initially becoming infected by a virus before passing it to the unborn fetus which can increase the risk of HIE if not properly managed.
  • Placental Insufficiency
    • Placental insufficiency, otherwise known as placental dysfunction or uteroplacental vascular insufficiency, is a serious complication of pregnancy. The condition is a result of the placenta failing to develop properly. This can lead to inadequate oxygen and nutrient supply to the baby from the mother’s bloodstream and can increase the risk of HIE.
  • Severe Fetal Anemia
    • Severe fetal anemia is the result of red blood cells and hemoglobin falling below normal levels within the fetus. Hemoglobin carries oxygen so any restriction in the flow of hemoglobin to the fetus and can increase the risk of HIE.

During Labor and Delivery HIE May Be Caused By:

  • Delayed Delivery or Cesarean Section
    • When a baby is left in oxygen-depriving conditions because the physician spends too much time trying to deliver the baby vaginally and a C-section is delayed, the oxygen deprivation can cause HIE and other permanent brain injuries.
  • Umbilical Cord Complications
    • The umbilical cord is the lifeline of the unborn. Any complications affecting the umbilical cord, such as compression or anything else that reduces its function, may put the baby at a heightened risk of HIE.
  • Placental Abruption
    • Placenta abruption is a potentially serious complication during pregnancy in which the placenta becomes prematurely detached from the uterus prior to birth. The detachment can cause the unborn to become dangerously deprived of oxygen.
  • Excessive Use of Painkillers or Anesthesia
    • Excessive use of painkillers or anesthesia may reduce uterine activity. A decrease in uterine activity may lead to an increase in the length of labor which may lead to HIE.
  • Abnormal Fetal Position
    • Abnormal fetal positions such as transverse fetal lie and breech, face, and brow presentation may increase the risk of HIE.
  • Maternal Hypotension
    • Maternal hypotension occurs when the mother has low blood pressure. The decreased blood pressure may lead to insufficient blood flood through the placenta and umbilical cord to the baby. The reduction in blood flow may deprive the baby of oxygen-rich blood which can lead to HIE.

After Delivery, HIE May Be Seen With:

  • Severe prematurity
  • Infants born prematurely have increased rates of developing HIE.
  • Respiratory failure or cardiac arrest
  • Respiratory failure or cardiac arrest in the newborn may lead to increased chances of HIE development.
Inforgraph: understanding hypoxic ischemic encephalopathy

Signs and Symptoms of HIE

Signs and symptoms of HIE vary greatly and are often dependent on the underlying severity and extent of the brain injury, as well as the region of the brain affected.

Doctors are not likely to admit that their handling of the delivery caused your baby to develop HIE.

While signs and symptoms do vary, signs of HIE at birth may include the following:

  • Abnormal movements or seizures.
  • Weakened muscles, and lack of muscle tone, otherwise known as Hypotonia.
  • Difficulty feeding, including the inability to latch, suck, or swallow, due to weak muscles in the throat and mouth.
  • A weakened cry.
  • If at birth your baby appeared blue and required resuscitation.
  • Your baby seems unusually unreactive to sight and sound stimuli. For example, your baby may not react to changes in light.

Additionally, A low APGAR score may suggest the newborn suffers from HIE. The APGAR test is given to newborns soon after birth, and it assesses the baby’s heart rate, muscle tone, and other signs to see if extra medical care or emergency care are needed.

APGAR is an acronym that stands for:

  • Appearance: Is the baby abnormally pail or blue?
  • Pulse: Does the baby have a normal heart rate?
  • Grimace (reflex irritability): How does the baby respond to stimuli?
  • Activity: Does the baby exhibit normal joint movement and flexibility?
  • Respiratory effort: Does the baby exhibit labored breathing or crying?

Diagnosing HIE

Diagnosing HIE commonly involves the use of several tests in combination with neuroimaging. These tests usually include:

  • CT scans
  • PET scans
  • MRIs
  • Blood glucose tests
  • Umbilical cord and arterial blood gas tests
  • EEGs
  • Ultrasounds

The results of these tests will be evaluated by a neurologist. If significant risk factors such as fetal distress or low heart rate occurred during labor or delivery, HIE may be expected, and thus diagnostic tests should be conducted.

Newborns who suffer from HIE may not show signs of a hypoxic-ischemic injury until later in childhood. These signs commonly include delays in developmental milestones for metrics such as motor skills, growth, and cognitive function.

Treatments for HIE

While there is no definitive treatment for HIE, that are treatments aimed at addressing affected organs such as:

  • Medication to control seizures
  • Ventilation machines to aid in breathing
  • Treatments aimed at stability heart and blood pressure
  • Sustaining kidney and liver function

The only brain-specific treatment that has been proven to mitigated neurodevelopmental handicaps is brain cooling.

Brain cooling, or, therapeutic hypothermia has been shown to improve a baby’s survival rate, and aid in reducing the extent of permanent brain injury. By lowering the temperature of the baby’s body, and brain, recovery on a cellular level may occur, as well as an increased chance of limiting the extent of future disability.

The treatment involves placing the baby in a cooling blanket for three days. During this period, medical staff should provide supportive care which may include, helping the baby breathe, controlling and preventing seizures and low blood sugar, and minimizing brain swelling.

After three days of treatment the baby’s body and brain will slowly be re-warmed to normal temperatures.

Infograph: How Does Hypothermia work?

 

In addition to brain cooling, other treatments include:

  • Supporting the heart and maintaining healthy blood pressure
  • Sustaining kidney and liver function
  • Mechanical ventilation (breathing tube) if the baby is unable to breathe independently
  • Medications for babies who have seizures

Legal Help for Children With HIE

HIE cases are legally and medically complex. Though some injuries occur without fault, the unfortunate reality is that many of these incidents are avoidable and are caused by the negligence of medical staff.

Due to their legal and medical complexity, you must have an attorney and law firm who are well-versed in the intricacies of birth injury and HIE litigation.

At Harris Powers & Cunningham, our attorneys have a litany of experience in birth injury law and are committed to securing just restitution for our clients. Harris Powers & Cunningham specializes in medical malpractice lawsuits and will offer compassion and expertise throughout the legal process.

Our office is located in Phoenix, Arizona. Contact us today to begin your free birth injury case review by emailing us or calling 602-910-6779.