What Are Three Stages of HIE?

The three stages of HIE or Hypoxic Ischemic Encephalopathy are generally defined as:

• Stage I – mild HIE
• Stage II – moderate HIE
• Stage III – severe HIE

This 3-stage classification system for HIE was developed in 1976 by researchers Sarnat and Sarnat. Nearly half a century later, it continues to be the most reliable staging system used globally to identify the severity level of the baby’s HIE birth injury and to determine whether the baby qualifies for therapeutic hypothermia to treat HIE.

Stage I, which describes mild conditions of HIE, is generally characterized by the following signs and symptoms of HIE in the baby noticeable immediately after birth:

• Overactive or hyper-alert baby
• Floppy muscles (slightly reduced muscle tone)
• Overly Fussy or irritable baby
• Brisk reflexes to stimulus
• Feeding problems
• Sleeping difficulties
• Crying more frequently than expected

These mild HIE symptoms often resolve in 24 hours or less, but may last longer in some babies. In any case, the medical team should carefully monitor all the Stage I symptoms and make appropriate medical interventions as necessary.

Stage II describes the moderate level of HIE injury, where the baby may show some or all of the following signs and symptoms:

• Significant muscle weakness (hypotonia)
• Continuous lethargy or sluggishness
• Difficulties in clapping or grasping with hands
• Lower reflexes in response to stimulus
• Difficulties in breathing
• Excessive irritability
• Feeble cries
• Disinterest in sucking
• Apnea (momentary breathing cessation)

Proper diagnosis, monitoring and interventions are critical in case of Stage II or moderate HIE in order to improve the child’s prognosis. Hypothermia therapy should be administered within the first six hours for babies who qualify for this treatment. The first few weeks are crucial for monitoring and medical care for babies with moderate HIE injury.

An MRI should be done after the hypothermia therapy to look for signs of long-term brain damage due to the HIE injury.

Stage III or severe HIE is the most dangerous or life-threatening condition for the newborn baby, which is usually marked by some or all of the following symptoms:

• The baby is in a coma-like stupor
• Unresponsive to physical stimulus
• Serious breathing problems, which may require ventilator
• Poor muscle tone throughout the body (generalized hypotonia)
• Absence of neonatal reflexes (no grasping, swallowing, or sucking)
• Fixed, unresponsive or dilated pupils
• Fluctuating blood pressure
• Irregular heart rate
• Treatment-resistant seizures (progressively increasing)

Severe cases of HIE injury may lead to permanent disabilities, including cerebral palsy, or even the baby’s death. The medical team should immediately administer hypothermia therapy to qualifying babies in this condition, and continue to monitor the baby’s symptoms in order to develop an appropriate care plan.

In addition to the observable signs and symptoms, the medical provider should order diagnostic tests, such as MRI scan to assess the nature and extent of brain damage for appropriate management. Medical treatment and therapy while in the Neonatal Intensive Care Unit (NICU) during the first few hours and days following an HIE insult can reduce the risk and severity of future complications, such as cerebral palsy.

Parents whose children are suffering from an hypoxic ischemic encephalopathy (HIE) want and deserve answers as to whether errors by the doctors and nurses during or just after the delivery contributed to their child’s birth injury.

At Miller Weisbrod Olesky, our award-winning cerebral palsy attorneys have represented families all over the United States in their time of need after a birth injury like HIE. We use our skills and expertise to obtain for you and your child a medical malpractice settlement that will help provide specialized medical therapy in order to maximize the quality of life and independence of your child throughout their life.

• Were there signs of birth injury or birth complications during the pregnancy, labor, and delivery process, or presence of risk factors, which were either not recognized or properly treated?
• During the labor and delivery, were there clear indications that the baby was suffering from fetal distress, but appropriate actions were not taken by the maternal fetal specialists, obstetrician or nurses?
• Was there a delay in diagnosis of a likely premature birth that led to later complications, including brain injury?
• Did the medical team fail to order a series of tests to diagnose this birth complication in a timely manner?
• Was the decision to perform a cesarean delivery delayed leading to birth trauma during vaginal delivery or labor?
• Did the neonatal resuscitation team fail to quickly begin important breathing support?
• Should brain cooling (also called “hypothermia therapy”) have been provided to your baby, but the doctors and nurses failed to perform the appropriate tests or ignored the results of the tests?

Our birth injury attorneys have recovered millions of dollars in settlements for families of children that have suffered a birth injury. 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, no matter how long or tough your case is.

Most birth injury law firms will employ one or two nurses to assist the review of cases and medical research. But Miller Weisbrod Olesky offers an unmatched number of nurses and nurse-attorney employees support to both the birth injury attorneys and our clients.

Our team of registered nursing staff and nurse-attorneys bring a deep level of medical and personal insight to every client’s case. Our nursing team includes both an experienced labor and delivery nurse as well as an ICU nurse. Working closely with the rest of the team, they investigate the reasons behind a birth injury and how medical professionals breached their standard of care.

Linda Chalk

As a registered nurse, Linda practiced ICU nursing for 44 years while caring for a wide range of patient conditions. She has worked closely with founding partner Les Weisbrod for over 30 years, investigating and pursuing birth injury cases.

Along with DJ Weisbrod, Linda heads up the firm’s birth injury intake, screening, and medical literature research team. She personally screens all potential cases to ensure that medical issues have been addressed before we file lawsuits on behalf of birth-injured children and their families.

DJ Weisbrod

Before joining Miller Weisbrod, DJ practiced as a surgical nurse in various hospital and operative settings. She has been with the firm over 30 years.

DJ directs Miller Weisbrod’s birth injury intake and medical screening team. She has also served as firm founder Les Weisbrod’s trial nurse for all cases involving medical negligence and birth injury.

Linda Cuaderes

Linda Cuaderes is both a registered nurse and a licensed lawyer. Linda works exclusively in Miller Weisbrod’s Birth Injury and Medical Malpractice section. Linda acts as the firm’s patient advocate and liaison with our young clients and their parents.

Linda combines her legal and nursing experience along with her exceptional organizational talent and attention to detail to make sure each child we represent is provided the highest level of medical care and attendant care during the pendency of their case. Linda communicates with our parent clients regularly to monitor their birth injured child’s treatment, provide guidance as to additional care and therapies and when necessary assist them in obtaining specialized medical providers.

Linda was raised in Bartlesville, Oklahoma and completed her Bachelor of Science in Nursing with Honors at the University of Oklahoma. She started as an Oncology Nurse at Presbyterian Hospital in Oklahoma City, quickly becoming the Assistant Head Nurse of the Outpatient Endoscopy Unit. Linda then entered the University of Oklahoma College of Law.

Following graduation, Linda joined Les Weisbrod in the Medical Malpractice Section. After taking time off to raise her three lovely children, Linda returned to Miller Weisbrod and her passion of holding healthcare providers accountable for preventable errors. Linda is active in the American Association for Justice, Texas Trial Lawyers Association, Dallas Trial Lawyers Association, and the Texas Bar Association. Linda is an active member of the Birth Trauma Litigation Group and Medical Negligence Section of the American Association for Justice.

She is admitted to practice before the Texas Supreme Court and routinely works on cases pending throughout the United States. Linda has worked with child victims of birth injury, their parents and other victims of medical malpractice in Texas, New Mexico, Oklahoma, Arkansas, Louisiana, Iowa, Ohio, New York, Alabama, Georgia, Arizona, Utah and Missouri.

Education

• University of Oklahoma - School of Law, 1990, J.D. - Norman, Oklahoma
• University of Oklahoma - School of Nursing, 1985 - Norman, Oklahoma

Bar Admissions

• Texas - 1990

Areas of Practice

• Birth Injury/Birth Trauma
• Medical Malpractice

Associations & Memberships

• Texas Bar Association
• American Association of Justice
• Texas Trial Lawyers Association
• Dallas Trial Lawyers Association

Kristin Jones

Kristin combines her medical and legal training to provide invaluable, passionate service to parents struggling to care for their birth-injured children.

Families often have questions as they go through the birth injury lawsuit process. Kristin diligently identifies and investigates all medical issues so the birth injury attorneys at Miller Weisbrod can answer those questions Kristin ensures that our birth injured children’s medical records are thoroughly reviewed and organized. Miller Weisbrod’s birth trauma litigation attorneys and medical experts retained by the firm need her services while pursuing justice for our clients.

Kelly Kunkel

Kelly Kunkel was born and raised in Dallas, Texas. She has 15 years’ experience in hospital based High Risk Obstetrics and Labor and Delivery bedside nursing care. Kelly graduated with an Associate’s Degree in Nursing from El Centro College in December of 1990 and received her Bachelor’s Degree in Nursing from West Texas A & M University in 2008; graduating with honors.

In addition, Kelly has over 25 years’ experience in medical malpractice case management and litigation and has worked with David Olesky for over 22 years. After many years of assisting in defending healthcare providers and hospital systems in medical malpractice cases involving complex litigation matters related to birth injury, catastrophic injury and death, Kelly has proudly joined David Olesky in the national birth injury and medical negligence practice at Miller Weisbrod Olesky.

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Why Should You Talk with the Highly Capable Attorneys at Miller Weisbrod Olesky?

The only way to find out if you have a birth injury case is to talk to a lawyer experienced in birth injury lawsuits. It’s not uncommon that a birth related complication results in a preventable birth injury, including cerebral palsy, but it takes a detailed expert review by a birth injury attorney of the medical records from your child’s birth to determine if the birth injury was the result of medical malpractice.

At Miller Weisbrod Olesky, a team of committed lawyers, nurses and paralegals uses our detailed medical negligence case review process to assess your child’s 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 pregnancy. We call in documented and proven 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 wrongful birth in your case, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors. Our birth injury attorneys have recovered millions of dollars in settlements for families of children that have suffered a birth injury.

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 no matter how long or tough your case is.