Preventing Hypoxic Ischemic Encephalopathy

Hypoxic ischemic encephalopathy (HIE) is a serious brain injury at birth that no one imagines could happen to their baby. While in the care of doctors, nurses, and all other medical professionals, parents expect that they will do all in their power to prevent their baby from enduring all types of devastating birth injuries.

But sometimes, healthcare providers make negligent errors while administering care during a mother’s pregnancy and labor. This negligence can come in the form of medication errors, missing a pregnancy complication, failing to carefully monitor fetal heart rates, or delaying a medically necessary C-section delivery. All of these mistakes can act as a contributing cause of HIE in infants, and it may give a family legal standing to file a medical malpractice claim.

Over the past three decades, the nationally recognized team of birth injury lawyers, registered nurses, and nurse-attorneys at Miller Weisbrod Olesky have established a proven track record of delivering justice for children and families across the United States who have suffered from all types of birth injuries.

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Hypoxic ischemic encephalopathy, commonly shortened as HIE, occurs when a child’s supply of oxygenated blood is restricted or cut off completely from reaching their brain. The brain heavily relies on this constant flow of blood and oxygen, especially when developing inside the womb.

Even just a few minutes without it can cause irreparable harm to critical structures like the basal ganglia, thalamus, and white matter inside the brain tissue.

While unfortunately not all labor and delivery complications are preventable, a healthcare provider’s careful monitoring and swift action in the event of an emergency can be lifesaving and minimize the severity of a baby’s brain damage at birth.

Preventing HIE During Pregnancy

Examining a mother’s physical conditions during pregnancy is the first step in assessing her child’s birth injury risk factors. Proper prenatal testing should be conducted early on to check the mother for any complications that may qualify her pregnancy as “high risk”.

Examples of these types of pregnancy complications include problems with the umbilical cord, fetal size abnormalities like macrosomia, or the baby resting in an abnormal fetal position in the third trimester.

Preventing HIE During Labor and Delivery

Most cases of HIE occur as the result of a labor and delivery complication that caused the baby to suffer from birth asphyxia. Many different complications can lead to this outcome, including:

• Prolonged and arrested labor
• Uterine hyperstimulation
• Umbilical cord problems such as nuchal cords and cord compression
• Placental complications such as an abruption or uteroplacental insufficiency
• Fetal Distress (Non-reassuring fetal heart rates)
• Uterine Ruptures

Many of these complications are correlated and can happen at the same time. Or sometimes they may cause each other to occur. There are certain cases where these pregnancy complications aren’t preventable, but action can always be taken in response to a problem and healthcare professionals are expected to carry out the proper procedures quickly and accurately.

Proper Fetal Heart Rate Monitoring

A baby’s heart rate before birth is a critical indicator of their wellbeing. Doctors and other healthcare professionals are held to strict standards when it comes to monitoring fetal heart rate patterns and making decisions based off of them.

During labor, the baby’s heart rate is carefully tracked using electronic fetal heart rate monitoring equipment. The reading strip comes back in two pieces: the top part of the strip measures the baby’s heart rate, and the bottom part measures the mother’s contractions. Each red line indicates one minute.

Concerning heart rate patterns like late decelerations or absent variability can indicate that the baby is in fetal distress and receiving neither adequate oxygen nor blood flow. Catching these concerning patterns is one of the best ways to prevent prolonged hypoxia and greatly minimizes the baby’s risk for a hypoxic brain injury.

It’s important to note that fetal heart rates are often dynamic and fluctuating as the baby endures the stress of labor, and they can frequently evolve or shift over time. A fetal heart rate tracing should be interpreted in the context of the mother’s overall status.

There are times where fetal heart rates can appear concerning or non-reassuring and the baby ends up being perfectly healthy, but doctors and healthcare providers should always either quickly correct the non-reassuring heart rate tracings or move to delivery to protect the child. Failing to recognize abnormal heart rates or not acting quick enough can lead to brain damage at birth and can be grounds for a medical malpractice case.

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Fetal Heart Rate Monitoring

Administering Medications

While certain medication errors can cause or worsen delivery complications (such as uterine hyperstimulation, for example), proper usage can prevent birth injuries like HIE. When a mother is experiencing a prolonged labor due to weak contractions, doctors can prescribe labor-inducing medications.

These medications can speed up labor and help safely deliver a baby stuck in the womb and enduring prolonged uterine contractions. But it is critical that the baby is closely monitored when these medications are used because of how easily complications can occur.

Other medications can help progress fetal lung development for premature babies, such as Betamethasone. This type of medication can reduce the baby’s risk of respiratory distress syndrome (RDS) upon birth and requiring neonatal resuscitation.

In some cases, tocolytic medications may also be given to the mother to delay or prevent her preterm labor, allowing the baby more time to develop in the womb. Brain injuries and birth defects are less likely to occur when a baby stays in the mother's uterus for a longer period of time.

When used correctly, these medications can reduce the baby’s risk for developing injuries like HIE at birth. But regardless of which type of medication healthcare providers prescribe, they must be responsible for closely monitoring the mother and baby and ensuring the mother is given the correct dosage as well as adjusting that dosage if it is incorrect or if it starts to cause additional labor and delivery complications.

Performing Emergency Cesarean Deliveries

A Cesarean delivery (or a C-section) is a medical procedure used to deliver a baby through incisions in the abdomen and uterus. It is performed when vaginal birth is too risky, or when it becomes too unsafe to wait any longer.

A C-section is generally thought of as a “last resort” delivery method because of the toll it takes on the mother’s body, but it becomes medically necessary in cases where the baby is already experiencing severe oxygen deprivation.

The American College of Obstetricians and Gynecologists (ACOG) recommends that emergency C-sections start within 30 minutes from the time the decision is made until the first incision.

But ACOG recognizes that some C-sections must be performed faster depending upon the emergency condition.

Such conditions can include fetal heart monitor strips showing a dangerous lack of oxygen to the baby, a mother’s uterine rupture, umbilical cord prolapse, or a placental abruption or placenta previa. The labor and delivery team is expected to be equipped to perform a C-section if needed and start it promptly without delay for the best chance at avoiding birth complications.

Needlessly delaying an emergency C-section is one of the most common causes of prolonged birth asphyxia that leads to HIE. Doctors must act quickly when deciding to operate for the best chance of preventing or, at the very least, minimizing the effects of a hypoxic brain injury at birth.

Once the baby has been delivered, less can be done to fully prevent hypoxic ischemic encephalopathy in the newborn as the damage has likely already occurred. However, there are multiple stages of HIE that progress in severity, and certain birth injury treatments can help to minimize the long-lasting impacts HIE can have on the child’s brain.

It is the responsibility of medical professionals to perform these medical procedures when they deem it necessary for the newborn’s wellbeing.

Performing Neonatal Resuscitation

About 1% of newborns will need extensive neonatal resuscitation to avoid or minimize birth-related brain injuries like HIE. This is most common in infants who are premature, which is a known risk factor for HIE. Babies with shallow breathing, weak muscle tone, an absent cry, and all-around low APGAR scores are likely contenders for needing resuscitation or some form of respiratory therapy.

Once it has been decided to resuscitate the infant, the medical team should begin the following procedures done in sequence:

• Stabilization: They should provide warmth, position the baby to make breathing easier, clear the baby’s airway, stimulate the baby, and reposition them if necessary.
• Ventilation: If the baby’s breathing has not improved, the team then provides additional ventilation. For example, they may give supplemental oxygen or positive pressure ventilation.
• Chest compressions: The team may move on to chest compressions if their previous efforts have not worked.
• Medication: Hormone medications like Epinephrine can stimulate breathing and heart rate. Other medications help with respiratory volume expansion.

Healthcare providers must carefully follow these steps, along with all other procedures and techniques they employ when resuscitating a baby or while administering any form of respiratory therapy. When neonatal breathing is mismanaged, it greatly increases an infant’s chances for hypoxia, further brain damage, and death.

Administering Therapeutic Hypothermia

Brain injuries can progress within the first hours and days of a newborn’s life. However, a specialized treatment called therapeutic hypothermia, or neonatal cooling, can stop that progression and possibly minimize brain damage for some babies.

The therapy involves cooling the baby’s core temperature to around 92.3 degrees Fahrenheit. After 72 hours, medical staff begin to gradually rewarm the baby while simultaneously monitoring their vital signs. Cooling or rewarming too quickly can harm the baby’s brain and other organs.

Timing is incredibly important when beginning the brain cooling process. The treatment has been shown to be the most effective when it is started within the first six hours of the baby’s life, with a preference for as early as possible.

But sometimes the baby must be transported to the closest available hospital with the proper equipment for brain cooling. In these cases, healthcare providers should begin treatment by starting what’s known as passive cooling. Passive cooling involves using ice packs, removing warming equipment, and removing the infant’s clothing to begin gradually lowering their internal temperature.

While therapeutic hypothermia will not cure the child from HIE, it can minimize the extent of the injury and likely result in the baby experiencing only mild symptoms rather than severe ones. It is for this reason that delaying or failing to start brain cooling treatment can worsen the baby’s condition and count as medical malpractice.

As illustrated above, an HIE diagnosis can stem from a multitude of complications that interact together. And parents deserve to know when these complications are caused or amplified by medical mistakes.

Medical negligence, such as missing pregnancy complications, failing to properly monitor fetal heart rates, or needlessly delaying C-sections, can all play a role in a child’s brain damage at birth.

If a family believes that any of these mistakes contributed to their child’s diagnosis of hypoxic ischemic encephalopathy, legal support may be an option. A specialized birth injury attorney can review the medical records and circumstances to assess whether a viable claim for medical malpractice exists.

Parents whose children suffer from the long-term effects of birth complications, especially HIE and the life changes that come with it, deserve to know whether it could have been prevented. Our dedicated birth injury lawyers want to help you find those answers and obtain the funds necessary to improve the quality of life for your child.

Sometimes families are hesitant to reach out to a birth injury malpractice attorney or law firm. They may feel overwhelmed by their circumstances or are worried that a law firm will not be able to help them. But the only way to find out if you have a case is to talk to an attorney who understands how birth injuries can lead to developmental delays and other birth complications that require long-lasting medical and financial support.

A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the type of case and the state where it is filed. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to personal property, fraud, contract disputes, and collection of debts.

Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule, and in some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.

For example, if the party that injured you was:

• A federal employee
• Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity

You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, if the negligent party was a local or state government hospital or the doctors and medical providers are employees of a governmental entity, the time period in which you must give "notice" may be shorter.

If your case is filed outside of the statute of limitations, it will typically be dismissed, and you will not be eligible to recover compensation for your injuries. Determining when a statute of limitations begins on your case can be tricky. If you're considering pursuing compensation for a birth injury, contacting an attorney as soon as possible is in your best interest.

It takes a detailed expert review of the facts and circumstances of your pregnancy and your child's birth before determining whether their hypoxic ischemic encephalopathy diagnosis came as the result of medical malpractice.

Our Process

At Miller Weisbrod Olesky, a team of committed birth injury attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential birth injury case.

We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child's injuries.

If we feel medical negligence caused or contributed to your child’s HIE, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do. The sooner you reach out to us, the sooner we can begin investigating your case and gathering the evidence needed to support your claim.

We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. Contact us today to schedule your free legal consultation by calling our toll-free line at 888-987-0005 or by filling out our online request form.