What Causes HIE?

Hypoxic ischemic encephalopathy, known more commonly by its 3 letter initialism HIE, is a complex brain injury that permanently affects a child’s physical and cognitive functioning. It is the most common form of brain damage at birth.

HIE can inflict long-lasting injuries and disabilities for newborns, including low APGAR scores, seizures and epilepsy, vision impairments, and delayed developmental milestones like issues with speech, feeding, and learning. It is also the leading cause of cerebral palsy.

Parents of children who suffered an HIE diagnosis will naturally want to know what ultimately caused it. And perhaps even more than that, they will want to know if it could have been prevented.

While hypoxic ischemic encephalopathy cannot always be prevented, careful management of complications during pregnancy and during labor and delivery can decrease the risk of a more severe case. In some instances, quick intervention and proper birth injury treatment can prevent HIE altogether. But when OB-GYNs, nurses, midwives, and all other medical professionals make preventable errors or fail to notice critical complications, it can worsen the baby’s symptoms and lead to more severe brain damage or even death.

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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Encephalopathy refers to dysfunction in the brain. It derives from the Greek word enkephalos, meaning “within the head.” Encephalopathy can stem from a disease, an infection, or any other event that causes a brain injury and impacts cognitive functioning.

There are many different types of encephalopathy, including metabolic encephalopathy, toxic encephalopathy, hepatic encephalopathy, and uremic encephalopathy. The different types are always named after what’s directly causing the brain damage.

Hypoxic describes anyone or anything in a state of reduced oxygen. Hypoxia typically refers to insufficient oxygen, not necessarily a complete cutoff. When oxygen is completely cut off, it’s known as either asphyxia or anoxia.

Ischemic refers to an insufficient amount of blood traveling to the organs. In the context of HIE, the organ with inadequate blood flow is the brain. Because oxygen travels through the bloodstream, hypoxia and ischemia often go together.

Hypoxic-ischemic encephalopathy is sometimes called neonatal encephalopathy because it primarily develops during birth, but on rare occasions it can occur in older children and adults.

By definition, the cause of a newborn’s HIE diagnosis will always trace back to an event that blocked a sufficient amount of oxygen and blood flow from getting to their brain. Many different complications during pregnancy and labor can cause this to happen. Listed below are some of the most common causes for a hypoxic-ischemic event.

Birth asphyxia refers to a child’s oxygen supply being completely cut off from their brain, either during pregnancy or during labor and delivery. Within a very short timeframe, birth asphyxia can lead to brain damage, loss of consciousness, or even death for the infant.

In the womb, oxygen travels through the bloodstream, going from the mother’s placenta and through the umbilical cord to the fetus. When this supply is reduced for any given reason, it is known as hypoxia. Hypoxia becomes asphyxia (or anoxia) when the oxygen supply becomes completely blocked. This is a medical emergency that can be observed during labor by abnormal fetal heart rate decelerations and little to no fetal movement, two common signs of fetal distress.

Neurons in the brain begin to die off without oxygenated blood for prolonged periods, and the damage sustained to the brain can become irreversible within just minutes. Hypoxic-ischemic encephalopathy is the most common result of asphyxia at birth.

Medical Mistakes That Can Cause or Worsen Birth Asphyxia:

• Failing to conduct proper fetal heart rate monitoring.
• Delaying an emergency Cesarean (C-section) delivery.
• Not reducing the dosage of labor-inducing medications when it causes excessive uterine activity.
• Not prescribing sufficient medications when maternal infections like chorioamnionitis threaten a mother’s or child’s oxygen supply.
• Failing to provide supplemental oxygen to the mother when necessary.
• Using excessive force when using assistive delivery instruments like forceps and vacuum extractors.

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About Birth Asphyxia

The umbilical cord is the baby’s lifeline during pregnancy. Attached to the placenta, the cord is the vessel by which blood, oxygen, and other nutrients travel from the mother to the baby. If a child’s access to these nutrients is disrupted, they are at risk of developing several hypoxic and ischemic injuries, including brain injuries like HIE.

Examples of umbilical cord complications include knots (known as true knot), wrapping around the baby’s neck (nuchal cord), or having the cord compressed by the child’s weight pressing against it. Other abnormalities, such as the cord being too long or too short, can serve as risk factors as well.

Umbilical cord problems can increase the chances of birth asphyxia, which can lead to fetal distress and injuries like HIE when not caught and treated promptly by OB-GYNs, nurses, and other healthcare professionals.

Medical Mistakes That Can Cause or Worsen Umbilical Cord Problems:

• Failing to conduct adequate prenatal checkups and missing an umbilical cord complication.
• Failing to recognize an umbilical cord complication as a threat, leading to further injury to the mother or her child.
• Failing to conduct an emergency c-section procedure in the event of an umbilical cord complication during labor and delivery.
• Injuring the mother or her child with forceps and vacuum extractors in the event of an umbilical cord complication during labor and delivery.

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About Umbilical Cored Problems

The placenta plays an incredibly important role in a baby’s development inside the womb. It is the source of vital nutrients, hormones, and oxygen that keeps the fetus alive and prepares the mother’s body for pregnancy.

When a complication arises with the placenta, it jeopardizes the baby’s critical oxygen supply and can put them at risk for hypoxic and ischemic brain damage that can cause HIE.

One of the most dangerous complications is a placental abruption, where the placenta prematurely detaches from the uterine wall. Depending on whether the abruption is partial or total, this can weaken or even completely destroy the placenta’s ability to provide oxygenated blood and nutrients.

Other complications, such as placental insufficiency, can occur when a mother is overdue with a post term pregnancy. This can cause the placenta to not function properly and deprive the baby of oxygen and other nutrients, resulting in low birth weight or birth asphyxia.

These types of placental complications can directly increase the baby’s risk for brain damage at birth.

Medical Mistakes That Can Cause or Worsen Placental Complications:

• Failing to conduct adequate prenatal checkups and missing a placental complication.
• Missing the signs of placenta previa or failing to monitor it, resulting in an abruption.
• Not preparing for placental insufficiency in the case of a post term pregnancy.
• Leaving a retained placenta inside the mother’s body after giving birth, increasing her risk of infection.

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About Placental Complications

During labor, the mother’s contractions temporarily restrict the flow of oxygenated blood. This process is natural, but a baby can only go so long with diminished oxygenation before they go into birth asphyxia and their heart rate starts to drop. When labor is prolonged, it increases the risk of depriving the baby from oxygenated blood flow beyond a safe interval, which can cause HIE if not addressed quickly.

A number of different labor and delivery complications can prolong or arrest the mother’s labor, including:

Uterine hyperstimulation refers to when a mother’s contractions become too frequent and too forceful to the point where the baby’s safety becomes at risk. While uterine hyperstimulation can happen naturally, the overwhelming majority of cases develop as a birth complication from induced labor medications. These labor inducing medications are needed when the mother’s contractions are weak, erratic, or fail to begin at all.

However, the misuse or overdosage of labor-inducing medications can cause the mother to have contractions that are too frequent and too strong. It can also increase her risk for other injuries like a uterine rupture, placental abruption, or excessive bleeding.

Uterine hyperstimulation can place excessive force on the baby’s head, leading to cerebral compression and cranial molding. It can also cause umbilical cord compression, restricting blood flow and depriving the baby of oxygen for far longer than normal contractions would. In the worst cases, this will lead to hypoxic and ischemic injuries to the brain like HIE.

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About Uterine Hyperstimulation

Different fetal size abnormalities can increase the threat of prolonged labor. Conditions like macrosomia (when the baby is larger than average in size) can complicate vaginal delivery, as well as other complications like cephalopelvic disproportion (where the baby’s head is too large to fit through the mother’s birth canal).

These issues have the potential to prolong labor past the point of safety, leading to injuries like HIE when not addressed quick enough. In these cases, doctors should carefully monitor fetal heart rates during labor and prepare for an emergency C-section delivery if vaginal delivery is failing to progress.

Shoulder dystocia is a labor and delivery complication that occurs when one or both of the baby’s shoulders become stuck behind the mother’s pubic bone in the pelvis. It is typically diagnosed within one minute after the baby’s head delivers, but the rest of the body remains lodged inside the birth canal.

Shoulder dystocia cuts off blood circulation to the baby’s head, increasing their risk for brain damage like HIE. It can also cause spinal cord injuries, which can be linked with HIE and cerebral palsy symptoms. Shoulder dystocia can be treated using several different removal methods, including the use of assistive delivery instruments like forceps and vacuum extractors.

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About Shoulder Dystoncia

Fetal position is very important when it’s time for labor and delivery. Unborn babies usually spin and flip within their mother’s uterus until a few weeks before delivery. But most babies eventually settle into one position shortly before birth, which is almost always established by the 36th week of pregnancy.

Breech position is one of the most common types of abnormal fetal positioning where the baby’s feet are pointed toward the birth canal. Most babies are positioned to come out head-first, and any other positioning can present serious risks to the mother’s health during delivery.

About 3-4% of deliveries are breech presentations. Babies that are at breech at 37 weeks of pregnancy will not change on their own from this position. Doctors usually deliver breech babies by C-section because the baby is at risk for umbilical cord compression, spinal cord injuries, nerve damage, birth trauma, and hypoxic-ischemic injury due to reduced blood and oxygen flow to their brain.

Labor and delivery medical teams must be prepared to perform emergency cesarean (c-section) deliveries whenever an abnormal position is known or suspected so they can prevent the baby suffering from oxygen deprivation.

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About Abnormal Fetal Positions

A pregnancy is considered “high risk” when she endures a pregnancy complication that threatens the wellbeing of her baby. These complications are normally caught and treated during prenatal testing, but sometimes OB-GYNs and other healthcare professionals miss the signs of a critical issue.

Examples of pregnancy complications that can cause HIE include:

Preeclampsia is a complication characterized by sudden high blood pressure that usually appears after 20 weeks and often near the end of a woman’s pregnancy. It is one of multiple different issues during pregnancy that can cause high blood pressure, along with eclampsia, gestational hypertension, and Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP syndrome).

Increased blood pressure during pregnancy can decrease the level of blood flowing through the placenta and to the baby. Certain medications like magnesium sulfate may be administered to reduce high blood pressure and prevent maternal seizures. However, when preeclampsia is improperly monitored or left untreated, it can lead to ischemia for the baby. It also can diminish oxygen levels as oxygen travels primarily through the blood.

Doctors have a legal duty to their patients to recognize the potential for serious conditions like preeclampsia. Failing to do so puts the mother’s unborn child at risk for severe brain injuries like hypoxic-ischemic encephalopathy (HIE) and even death.

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About Preeclampsia

Untreated maternal infections can pose a critical threat to the baby’s health. Doctors will often prescribe medications like antibiotics or steroids to fight off infections like Group B Strep or chorioamnionitis.

When a mother has an infection during pregnancy, she carries the risk of passing it to her unborn child in the womb. These neonatal infections can cause inflammation within the brain and reduce their oxygen supply, which can put them at risk for HIE and other brain injuries.

Infections that have been linked to the risk of brain damage and HIE include chorioamnionitis, meningitis, encephalitis, cytomegalovirus, and sexually transmitted diseases like herpes simplex virus and human immunodeficiency virus (HIV).

When untreated and passed to the baby, the infection can cause swelling and inflammation in their developing brain. Sometimes the inflammation can occur throughout the baby’s body, a condition known as neonatal sepsis. Another possible complication of untreated infections is jaundice, a yellowing of the skin caused by high levels of bilirubin in the blood. Complications like sepsis and jaundice can dramatically increase a newborn’s chances for brain damage at birth, including hypoxic-ischemic encephalopathy.

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About Maternal Infections

Amniotic fluid is a liquid within the uterus that surrounds the fetus during pregnancy. It is crucial to temperature regulation, organ development, and fetal protection from impacts while the child grows in the womb.

Too much amniotic fluid in the womb (known as polyhydramnios) can increase the risk of placental abruptions, umbilical cord prolapses, and the premature rupture of membranes (PROM). On the other side of the spectrum, too little amniotic fluid (known as oligohydramnios) can cause neonatal infections, meconium aspiration, underdeveloped lungs, and rapid fetal heart rate decelerations.

All of these birth complications pose a threat to the baby’s oxygen supply, which increases the risk of an HIE brain injury at birth.

Blood clots during pregnancy can be dangerous for both the mother and her baby. The main concern is that they can cut off blood flow to the mother’s organs and the umbilical cord, which is extremely detrimental to the child’s development during gestation.

Blood clots that develop in the placenta are especially dangerous as it is the main organ responsible for delivering oxygen and nutrients to the fetus. A placental blood clot can lead to placental abruption (when the placenta detaches from the uterine walls) or cause other placental complications that can result in a miscarriage or stillbirth.

When blood flow is deprived from the baby for too long, it can result in ischemic injuries like HIE and cause other birth complications like intrauterine growth restriction (IUGR).

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About Blood Clots During Pregnancy

A uterine rupture is a medical emergency where the mother’s uterus rips or tears from the stretching and pressure of the baby’s weight on it. It is more likely to occur in women who have previously had a C-section delivery, but genetic factors can also play a role in creating a weaker uterine wall.

After a complete uterine rupture, the mother is sure to endure a fair amount of internal hemorrhaging. The mother’s severe bleeding reduces blood flow to the baby, which will consequently affect their oxygen supply.

When this happens, the baby is likely to develop Hypoxic-Ischemic Encephalopathy if the cutoff from oxygenated blood is prolonged. Doctors must quickly prepare the mother for a C-section delivery to prevent the baby and other contents of the uterus from spilling out into her abdomen.

Medical Mistakes That Can Cause or Worsen a Uterine Rupture:

• Failure to observe high risk pregnancies more closely
• Failing to schedule a C-section before the mother’s due date instead of trying TOLAC (Trial of Labor After Cesarian)
• Not preparing for VBAC (Vaginal Birth After Cesarian) mothers in low-staffed and unequipped hospitals
• Failing to inform patients of the risks of vaginal birth after cesarean (VBAC)
• Not watching for fetal presentation issues
• Failing to closely monitor the baby for signs of fetal distress

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About Uterine Ruptures

A non-reassuring fetal heart rate (formerly called “fetal distress”) refers to a fetal heart rate or rhythm that is abnormally high or low, which is almost always an indicator of oxygenation issues.

Babies of expecting mothers with identified pregnancy complications like gestational diabetes and preeclampsia have a higher risk of a non-reassuring status and must be closely observed leading up to labor. But other complications during labor and delivery can send a baby into fetal distress as well. Examples include a prolonged labor or issues with the placenta or the umbilical cord, all of which can reduce oxygen supply and cause birth asphyxia.

Just like the brain, the heart requires a constant oxygen supply to pump blood to the rest of the body. When there is a deficiency (hypoxia) or a complete cutoff (asphyxia), can strain the heart muscle and weaken it. This can result in breathing problems and brain injuries like HIE at birth.

Medical Mistakes That Can Cause or Worsen Fetal Distress:

• Neglecting or failing to detect a pregnancy complication that could impact fetal heart rates.
• Failing to conduct proper fetal heart rate monitoring.
• Delaying an emergency Cesarean (C-section) delivery.
• Not intervening during a prolonged or arrested labor.
• Mismanaging a maternal infection or neonatal infection.

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About Fetal Distress

A Cesarean delivery, known commonly as a C-section, is a delivery method where an incision is made into the mother’s abdomen and uterus. The baby is then removed manually from this opening. C-sections are common in emergency situations when vaginal birth will take too long or is otherwise deemed to be too risky.

Babies who show signs of fetal distress or other complications like macrosomia and cephalopelvic disproportion (when the baby’s head is too big to fit through the mother’s birth canal) are typically delivered via C-section. Other labor and delivery complications like prolonged labor and uterine hyperstimulation can be grounds for an emergency C-section as well.

The biggest error a labor and delivery team can make with C-sections is delaying it past the point of safety. 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 sometimes even 30 minutes is too long to wait.

Conditions where a C-section must be started in less than 30 minutes can include a uterine rupture, umbilical cord prolapse, placental abruption or previa, and when fetal heart monitor strips are indicating a dangerous lack of oxygen to the baby.

If a C-section is needlessly delayed, the prolonged oxygen deprivation can result in brain injuries at birth like HIE.

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About C-Section Errors

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 medical 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 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 the brain injury that led 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.