Hypoxic Ischemic Encephalopathy*

At Medical Law, we understand how overwhelming a diagnosis of Hypoxic Ischemic Encephalopathy (HIE) can be.   Families are often left without important answers regarding the cause of their child’s birth injury, the resources available for rehabilitation, and the funds necessary to ensure their child’s – well being.

Adapting to a new lifestyle with a child with HIE takes extraordinary time and effort.   Our goal at Medical Law is to provide you with information that will serve as a preliminary support system while your case is being pursued.

We will explain Hypoxic Ischemic Encephalopathy (HIE), provide details about your legal options and point you in the direction of valuable HIE & Disability Resources.

Medical Explanations

What Is Hypoxic Ischemic Encephalopathy (HIE)?

HIE, also commonly known as birth asphyxia or neonatal encephalopathy (NE), is a dangerous type of neonatal brain injury 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 occurs when the brain does not receive adequate oxygenation. With proper management in a hospital setting, HIE is almost always preventable. In order to understand HIE more fully, it is helpful to dissect the term itself:

  • Hypoxic refers to hypoxia, or a shortage of oxygen in the blood.
  • Ischemic refers to ischemia, or a shortage of blood flow to the brain.
  • Encephalopathy refers to the resulting brain damage.

Occurring in roughly 2-9 per 1,000 live births, HIE is a form of birth trauma that causes significant and permanent infant brain damage, lifelong disabilities, seizure disorders and epilepsy, motor function delays, intellectual impairments, cerebral palsy, neurodevelopmental impairments and even death. HIE is one of the most common causes of birth injuries and severe pediatric impairments and disabilities.

Hypoxic Ischemic Encephalopathy

Related Terms

  • Asphyxia: An emergency condition characterized by severe oxygen deprivation—particularly in the womb—causing death, disability or permanent injury.
  • Neonatal Encephalopathy (NE): A broad term used to describe disturbed neurological function in a newborn baby. Some signs and symptoms of disturbed neurological function in a newborn infant may include respiratory distress, feeding problems, depressed reflexes, low or high muscle tone (stiff or floppy appearance) and/or seizure activity. Hypoxic ischemic encephalopathy (HIE) is the most common type of neonatal encephalopathy.
  • Birth Asphyxia: A lack of oxygen flow to the brain before, during or directly after birth. Birth asphyxia is very dangerous and can lead to neonatal encephalopathy (NE) and hypoxic ischemic encephalopathy (HIE). Birth asphyxia is another term for intrapartum asphyxia.
  • Intrapartum Asphyxia (Intrauterine Asphyxia): A lack of oxygen flow to the brain before, during or directly after birth. Birth asphyxia is very dangerous and can lead to neonatal encephalopathy (NE) and hypoxic ischemic encephalopathy (HIE). Intrapartum asphyxia is another term for birth asphyxia.

Classification of HIE Based on Severity

Fetal oxygen deprivation occurs in varying degrees of severity. In this section, we’ll discuss the three main groups used to classify and describe the severity of hypoxic ischemic injuries.

  • Acute Profound Asphyxia: Acute profound asphyxia is the most severe form of hypoxic ischemic injuries. Commonly referred to as acute near total asphyxia, this form of hypoxic ischemic encephalopathy is caused by longer, more complete periods of fetal oxygen deprivation. Known causes of acute profound asphyxia include emergency pregnancy, labor and delivery complications such as uterine rupture, umbilical cord prolapse, placental abruption and terminal bradycardia.
  • Partial Prolonged Asphyxia: When partial prolonged asphyxia occurs, the baby generally suffers oxygen deprivation for around 30 minutes. Neonates can withstand oxygen deprivation for short amounts of time. However, neonatal brain damage associated with this longer form of birth asphyxia is severe and serious. Known causes for partial prolonged asphyxia include oligohydramnios, preeclampsia and hypertension, hypotension, strong contractions and uterine hyperstimulation, placental insufficiency, umbilical cord prolapse, umbilical cord compression, short umbilical cord length and nuchal cords.
  • Mixed Injury Pattern Asphyxia: When a neonate experiences oxygen deprivation patterns characteristic of both acute profound asphyxia and partial prolonged asphyxia, the type of HIE is classified as mixed injury pattern asphyxia. Mixed injury pattern asphyxia can occur before, during or after delivery.

HIE Damage

Signs and Symptons of HIE

Before discussing more detailed information about the signs and symptoms of HIE, it is important to understand the difference between signs and symptoms. Although signs and symptoms are often used interchangeably, they have distinct definitions:

  • Signs can be detected, measured and confirmed in clinical settings. For example, seizures and organ failure are signs of HIE.
  • Symptoms are solely based on a patient’s personal experience of his or her medical conditions. Since newborns cannot express their experiences of medical conditions in words, HIE diagnoses are typically based off clinical signs instead of symptoms.

Clinical signs indicating HIE may include:

  • Low Apgar scores
  • Weak or absent cry immediately after delivery
  • The need for infant resuscitation during the neonatal period
  • Seizures within the first 24 to 48 hours of life
  • Acidic blood, indicating profound metabolic or mixed acidemia
  • Abnormal levels of consciousness
  • Absence of brainstem reflexes
  • Tone and reflex abnormalities, including hypotonia (baby is limp or floppy) and hypertonia (baby is stiff or spastic)
  • Apnea (periods when the baby stops breathing for 20 seconds or more)
  • Feeding difficulties
  • Fever
  • Stiffness of the neck, indicating the baby has meningitis or meningoencephalitis
  • Hypotension
  • Organ failure or organ problems
  • Hyperglycemia or hypoglycemia
  • Coma

Clinical signs for HIE are readily seen by risk factors or abnormalities on the fetal monitor. Symptoms are often not a factor aiding in the diagnosis of HIE because newborns cannot yet use the language or expressions necessary to indicate their symptoms. Many children with HIE do not show signs or express symptoms until they are older. In order to detect signs of HIE, it is critical for medical personnel to thoroughly evaluate a newborn, particularly if an oxygen depriving event occurred. Additionally, family members, friends, teachers, caretakers or other people close to young children should closely monitor their behaviors and developmental milestones.

Causes and Risk Factors for HIE

The permanent brain damage associated with hypoxic ischemic encephalopathy (HIE) can result from a wide range of mishandled pregnancy, labor, delivery and neonatal problems. Whenever a medical professional fails to diagnose, treat, prevent, or manage a certain cause or risk factors for HIE and the result is an injury to the mother or baby, it is medical malpractice. In these situations, the parent or guardian is eligible to pursue a medical malpractice lawsuit in order to obtain compensation for him/herself and the child.

One of the most common causes of HIE is the failure to deliver a baby experiencing fetal oxygen deprivation in a timely manner. This is also one of the most common areas of medical malpractice involved in labor and delivery. Below is a list of several causes and risk factors for HIE. Each of the following complications, injuries, medical mistakes and scenarios compromise the flow of oxygenated blood to the baby’s brain.

  • C-section mistakes:
    • Delayed C-section
    • Delayed emergency C-section
    • Failure to perform C-section
  • Intracranial hemorrhages (brain bleeds)
  • Tachysystole (excessive uterine contractions)
  • Prolonged and arrested labor
  • Misuse of the labor induction drugs Pitocin and Cytotec
  • Misuse of delivery assistance tools, including vacuum extractors and forceps
  • Uterine rupture
  • Placental abruption
  • Placenta previa
  • Mismanaged uteroplacental insufficiency
  • Problems related to fetal size:
    • Cephalopelvic disproportion (CPD)
    • Macrosomia
  • Problems related to fetal presentation and position:
    • Face presentation
    • Breech presentation
  • Umbilical cord complications:
    • Nuchal cord
    • True knot
    • Umbilical cord prolapse
    • Umbilical cord compression
    • Short cord length
  • Preeclampsia (maternal high blood pressure)
  • Post-term pregnancy
  • Premature birth
  • Premature rupture of membranes (PROM or PPROM)
  • Polyhydramnios
  • Oligohydramnios
  • Anesthesia mistakes
  • Fetal stroke
  • Improper management of neonatal respiration
  • Fetal monitoring errors
  • Improper management of neonatal infection
  • Improper management of anemia
  • Chorioamnionitis and villitis
  • Meconium aspiration

What Instances of Medical Malpractice Can Cause HIE?

Standards of medical care require physicians, nurses, midwives and all other medical professionals to quickly and thoroughly diagnose, manage, treat and prevent any of the many possible causes and risk factors for HIE. However, instances of medical malpractice occur every year and thousands of newborns experience HIE. Below, we’ll list some instances of medical malpractice that cause fetal oxygen deprivation and HIE.

Instances of medical malpractice causing HIE include, but are not limited to, the following:

  • Medical professionals inaccurately read fetal distress signs on a fetal heart monitor, thereby failing to detect fetal oxygen deprivation
  • Medical professionals fail to timely deliver babies to avoid birth injuries
  • Medical professionals fail to detect, diagnose, treat, or manage a condition or complication that leads to hypoxic ischemic encephalopathy
  • Medical professionals fail to offer and/or perform hypothermia treatment on a qualifying newborn with hypoxic ischemic encephalopathy
  • Medical professionals mishandle neonatal respiration (ventilation) after delivery
  • Medical professional over- or under-administer anesthesia during labor and delivery
  • Medical professionals misuse forceps or vacuum extractors (labor and delivery assistance devices)
  • Medical professionals allow for the vaginal delivery of a baby that, due to risk factors, should have been delivered via C-section

Diagnosing HIE

In most cases, the diagnostic process for hypoxic ischemic encephalopathy begins once a medical professional notices one or more of the aforementioned clinical signs for HIE. Some factors that may prompt physicians to test include traumatic delivery, organ dysfunction, seizures within 24 hours of birth, or other present risk factors. Birth asphyxia diagnoses typically combine maternal-fetal history, laboratory testing, and physical and neurological examinations. Most diagnostic tests are completed in order to test brain functioning and assess how extreme the brain injury is. Once medical professionals suspect hypoxic ischemic encephalopathy occurred, diagnostic and neuroimaging tests are done to confirm the diagnosis. These may include the following:

  • MRIs
  • PET scans
  • CT scans
  • Ultrasounds
  • Blood glucose tests
  • Arterial blood gas tests
  • EEGs

It is critical that medical professionals diagnose HIE promptly. The sooner a baby is diagnosed with HIE, the sooner treatment and therapy measures can begin. In order to receive hypothermia treatment, the only known treatment for HIE currently, the baby must be diagnosed with HIE within six hours of the oxygen depriving insult. In many cases, unfortunately, signs and symptoms of hypoxic ischemic encephalopathy do not appear until later in the child’s development when he or she misses developmental milestones. In many of these cases, medical professionals fail to recognize early signs of HIE in a baby, thereby failing to perform hypothermia treatment. For this reason, a number of babies are not diagnosed with HIE in the neonatal period.

Side Effects of HIE

The effects of hypoxic ischemic encephalopathy depend on the severity of the oxygen-depriving insult, so individuals with HIE often experience varying side effects ranging from mild to severe. Medical professionals must take every precaution to prevent hypoxic ischemic events and, when HIE occurs, perform hypothermia treatment under the required indications. The following injuries, complications and lifelong disabilities are known to occur as a result of hypoxic ischemic encephalopathy:

  • Cerebral palsy (CP)
  • Intellectual and Developmental Delays (I/DD)
  • Movement disorders
  • Seizure disorders and epilepsy
  • Speech, communication and swallowing disorders including apraxia, dysphagia, oral aversion and speech delays
  • Kidney and renal disorders
  • Fine motor delays
  • Gross motor delays
  • Neurodevelopmental delays
  • Respiratory system problems
  • Endocrine system problems
  • Urinary and digestive system problems
  • Skeletal and musculoskeletal system problems
  • Microcephaly
  • Dysautonomia
  • Nystagmus
  • Strabismus
  • Visual impairment
  • Hearing impairment
  • Gastroparesis
  • Fetal death

Treatments and Therapy for HIE

Treatment for HIE

In the past, treatment of HIE solely included supportive care that focuses on preventing further brain damage. This meant lengthy NICU stays, mechanical ventilation, seizure management, blood glucose management, blood pressure maintenance and minimizing brain swelling.

Today, hypothermia treatment is the only procedure known to treat HIE. Also known as brain cooling, hypothermia treatment improves the health outcomes of babies with HIE by halting the progression of brain damage, thereby reducing the severity and permanence of brain injury. The treatment consists of lowering a newborn’s body temperature to around 91 degrees Fahrenheit for a period of about 72 hours. By lowering the baby’s temperature, the metabolic rate is slowed to allow cells to recover over a longer period of time. Without hypothermia treatment, normal oxygenation or blood flow is restored too quickly to injured cells, ultimately progressing the brain injury.

Before receiving hypothermia treatment, babies must meet some important prerequisite conditions:

  • The oxygen-depriving insult must have taken place within six hours of the onset of hypothermia treatment
  • The baby must have reached at least 36 weeks of gestation
  • No contraindications for hypothermia treatment can be present

Therapy for HIE

Because infants that suffer a hypoxic ischemic event at birth typically go on to live with permanent brain damage and disabilities, they are encouraged to take part in a variety of rehabilitation programs, medical procedures and lifestyle adjustments. The following therapeutic methods can help people with HIE improve functional ability and adjust to limitations:

  • Physical therapy
  • Occupational therapy
  • Speech-language therapy
  • Stem cell therapy
  • Recreational therapy
  • Special education
  • Alternative and complementary therapy
  • Animal-assisted therapy
  • Suit therapy
  • The use of adaptive equipment and assistive technology

Therapy plans are based on the individual’s personal rehabilitation needs and generally encompass one or more therapy techniques. Additionally, certain surgeries and medications may help with residual impairments from a hypoxic ischemic encephalopathy diagnosis.

Preventing HIE

Hypoxic ischemic encephalopathy (HIE) is largely a preventable birth injury. Since fetal oxygen deprivation and HIE are commonly the result of medical errors made at birth or around the time of delivery, preventing it often comes down to providing careful, quality obstetrical care. Because the permanent disabilities and injuries caused by HIE are so extreme, it’s critical that medical professionals follow all care standards in order to prevent fetal oxygen deprivation. Throughout this section, we’ll cover some of the basics surrounding birth injury and HIE prevention.

How Medical Professionals Must Prevent HIE

According to standards of medical care, it is the responsibility of all medical personnel to prevent HIE and birth injuries. This means that doctors, anesthesiologists, nurses, midwives, pharmacists, hospital staff and all other medical professionals interacting with an expectant mother and her baby must:

  • Prevent HIE and any of its causes or risk factors to the best of their ability
  • Properly manage any present causes or risk factors for HIE
  • Treat any causes or risk factors for HIE
  • Detect and diagnose HIE if it is present
  • Perform hypothermia treatment (brain cooling) for babies with HIE unless contraindications are present
  • Performing all other medical duties necessary to prevent and/or handle HIE

Preventative Procedures for HIE

We’ve discussed how the general management, prevention, diagnosis and treatment of the various causes and risk factors for HIE can help prevent the dangerous injury. In this section, we’ll specifically list some of the most common ways to prevent HIE. Some of these may include the following:

  • Performing elective C-section deliveries at 39 gestational weeks or sooner for certain high-risk pregnancies
  • Performing and planning C-section deliveries for those pregnancies with risk factors for HIE (such as in cases of cephalopelvic disproportion).
  • Properly interpreting fetal heart tracings to ensure the baby is not in distress around the time of delivery
  • Preventing prolonged labor and delivery
  • Swiftly performing emergency C-sections when dangerous causes or risk factors for HIE present themselves during vaginal delivery
  • Performing hypothermia treatment in newborn babies with HIE to halt the progression of brain injury

Your Legal Options

Legal Help For Your HIE Case

At Medical Law, we understand how overwhelming a hypoxic ischemic encephalopathy diagnosis can feel. Families are often left without important answers regarding the cause of their child’s birth injury, the resources available for rehabilitation, or the funds necessary to ensure their child’s well-being. While adapting to your new lifestyle will take time and care, we hope the information on this page will serve as a preliminary support system—here, we will offer an accessible explanation of hypoxic ischemic encephalopathy (HIE), provide details about your legal options and point you in the direction of some valuable HIE and disability resources.

Where To Start

Contacting a birth injury solicitor is the first step in securing a better life for your loved one with hypoxic ischemic encephalopathy. This year alone, thousands of parents will have babies diagnosed with HIE from medical negligence.

Unfortunately, the majority of these families will never reach out for legal help, thereby missing the opportunity to learn how their child’s injuries occurred and secure the important funds necessary for future care and rehabilitation. No matter where you are in the process, we are here to help.

If one of the following scenarios applies to you, a family member, a friend, or another loved one, we encourage you to reach out to us with your legal questions, concerns, and case inquiries:

You know a baby who was diagnosed with HIE, cerebral palsy, brain damage, or another birth injury

A complication or error occurred during pregnancy, labour, delivery, or the neonatal period and you are worried about the baby’s health

Your baby is in the NICU and you feel as though a medical mistake occurred

You suspect that medical professionals failed to meet standards of care

Your child is missing developmental milestones

Why Should I Pursue Legal Help for My HIE Case?

Providing care for an individual with hypoxic ischemic encephalopathy is both financially and emotionally demanding. Because the associated injuries and disabilities of HIE are often so imposing, it is unfortunate to note how many cases of hypoxic ischemic encephalopathy result from acts of negligence on the parts of medical professionals.

Regrettably, most of these individuals with lifelong disabilities from hypoxic ischemic encephalopathy will never enquire about their legal options, and fewer will ever pursue legal action.

Pursuing legal action for your hypoxic ischemic encephalopathy case is the first step towards a life of equal opportunity, rehabilitation and well-being for your injured loved one. Compensation from a successful medical negligence lawsuit will allow your family to more easily afford the support and care you need, including special education, treatment, therapy, adaptive equipment, recreational opportunities, housing, alternative guardianship, care and more.

When our HIE solicitors secure a settlement for clients with permanent birth injuries and HIE, they work closely with economists, life-care planners and other experts to determine exactly what resources your family will need to live comfortably.

Medical Negligence And Birth Injury

What is Medical Negligence?

Medical negligence occurs when a medical professional deviates from the standard of care, and that deviation causes injury or harm to the patient.

Medical Negligence, Pregnancy and Newborns

Any patient can fall victim to medical negligence, but newborns are particularly vulnerable to medical mistakes. Medical errors that occur during pregnancy, during labor and delivery, or in the neonatal period often result in life-changing or fatal injuries to both the mother and the baby.

Often, these medical errors cause hypoxic ischemic encephalopathy. Many children with HIE go on to live with cerebral palsy, seizures and epilepsy, learning disabilities intellectual and developmental disabilities (I/DD), movement disorders and more.

How Are HIE Cases Different Than Other Medical Negligence Cases?

Birth injury cases are both highly specific and complicated. Unlike other general medical negligence cases, it is important that your HIE solicitor knows and understands not only what can happen to a baby during the birthing process, but also the care a physician must provide before and after birth.

A solicitor must be experienced in the medicine and medical literature applicable to pursuing a birth injury case.

HIE solicitors must be able to access and interpret medical records, and obtain the support of qualified experts. These practicing experts and medical professionals often include obstetrics and gynecology doctors, maternal-fetal medicine doctors, forensic document examiners, placental pathologists, neonatologists, respiratory therapists, pediatric neurologists, pharmacologists, neuroradiologists, neuropsychologists, neurosurgeons, pediatric surgeons, anesthesiologists, genetics experts, infectious disease experts, economists, physical medicine and rehabilitation doctors, and many others.

The support of well-qualified experts is crucial to successfully pursuing an HIE medical negligence case. These experts define the standard of care that is required to be provided to the individual mother and baby, and define the future care that will be required.

Do I Have A Case?

Determining whether a child’s hypoxic ischemic encephalopathy is the result of medical negligence is crucial in determining eligibility for compensation permitted by the law.

Regretfully, a number of families avoid medical malpractice litigation for different reasons—some fear confrontation, some feel they don’t have the resources, some simply feel overwhelmed, and others doubt they have a case.

The best—and only—way to find out if you have a cerebral palsy case is to reach out to a solicitor for a legal consultation. An experienced birth trauma solicitor will do a thorough investigation of the medical records and review the case with expert medical professionals to determine whether negligent care was the cause of a child’s cerebral palsy.

Because all cases involve unique facts and injuries, result from varying instances of medical negligence, no two cases look alike.

Every day, the Medical Law birth injury team helps people determine whether or not they have a case. Our cerebral palsy solicitors and labour and delivery nurses gather medical records and important information about each specific prospective client in order to determine if medical negligence occurred.

Before filing a medical negligence case, our HIE solicitors contact a wide range of experts and medical professionals to confirm negligence. These practicing experts and medical professionals often include all obstetrics and gynecology doctors, maternal-fetal medicine doctors, forensic document examiners, placental pathologists, neonatologists, respiratory therapists, pediatric neurologists, pharmacologists, neuroradiologists, neuropsychologists, neurosurgeons, pediatric surgeons, anesthesiologists, genetics experts, infectious disease experts, economists, physical medicine and rehabilitation doctors, and many others.

Talk to Medical Law


Medical Law:   Our Priorities
As experienced solicitors, we know how to pursue these kinds of Hypoxic Ischemic Encephalopathy claims.  We understand the needs of our clients.   We can employ the resources to be effective in complex medical negligence litigation.
Medical Law:  Our Promise to You
We are dedicated to the service of our clients from our initial consultation and case review until we reach a settlement or judgment on your behalf.   Your best interests are our priority.  If you or a loved one have suffered due to medical negligence, we want to help you by finding out, what happened, who was responsible and holding that responsible party or parties to account.

*In contentious business a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement. This statement is made in compliance with Regulation 8 of S.I. 518 of 2002.

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Medicallaw.ie is a team of experienced solicitors and medical consultants who specialise in taking on medical negligence claims.

The team is headed up by Siobhan Fahy, Solicitor.

We are all well qualified in our respective fields and have years of experience in the area of medical negligence. We seek justice and financial compensation for patients who feel that they have been the victim of medical neglect.

We recognise the dedication of those who serve in our hospitals and health service, but the reality is that our health system is so inadequate that many people find they have become victims of a particular consultant or the Health Service Executive itself. We are here to help.

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