Hypoxic-ischemic encephalopathy (HIE) (also known as perinatal asphyxia) is a type of brain injury that results when the supply of blood and oxygen to a baby’s brain is temporarily cut off during childbirth.
What is Hypoxic Ischemic Encephalopathy (HIE)?
Encephalopathy is a medical term used to describe various conditions or diseases that result in damage to the brain. Hypoxic-ischemic encephalopathy (HIE) is an injury to the brain specifically caused by a combination of (a) an interruption or reduction in oxygen supply (hypoxia), and (b) a reduction of blood flow (ischemia). With perinatal HIE, the reduction of blood and oxygen flow to the baby’s brain takes place during or immediately after childbirth. It is a very dangerous condition that requires an emergency response by doctors and hospital staff. Hypoxic-ischemic encephalopathy is one of the leading causes of infant deaths during childbirth. It is also a leading source of very severe and disabling brain damages.
What are the Possible Effects of HIE?
Cases of perinatal hypoxic-ischemic encephalopathy can range from mild to severe. HIE occurs in about 3 out of every 1,000 births. Despite this relatively low rate of occurrence, HIE is still one of the leading causes of childbirth fatalities. Approximately 15-20% of all babies born with HIE die within the first few days. About 25% of HIE babies that survive end up with some degree of permanent brain damage which can cause severe mental and physical disabilities. The remaining percentage of babies born with HIE eventually recover and exhibit only mild signs of neurologic damage.
What are the Initial Symptoms of HIE?
The immediate signs and symptoms of hypoxic-ischemic encephalopathy following childbirth vary depending on whether it is a mild, moderate or severe case of HIE.
- Stiffened muscle tone and slightly abnormal tendon reflexes in the first few days
- Abnormal behavior such as poor feeding, unexplained irritability, excessive crying or sleeping
- Symptoms of mild HIE usually go away after the first few days
- Notable hypotonia (floppy baby syndrome) with very little tendon reflexes
- Very poor or absent grasping and/or suck reflexes
- Periodic apnea
- Seizures (typically within first 24 hours)
- Significant seizures occurring with increasing frequency over first 2 days
- Stupor or coma (no response to external stimulus)
- Irregular breather (ventilator may be required)
- Severe hypotonia (floppy muscle tone)
- Abnormal eye movements or eye control with pupils dilated
- Irregular heart rate and blood pressure
- Death from cardiorespiratory failure
Formally diagnosing HIE initially involves observation of the physical symptoms described above. Lab tests including tests of serum electrolyte levels and cardiac and liver enzyme tests are also utilized. Imaging tests including MRIs and CT scans will also be used to make a diagnosis.
What Causes HIE?
The interruption of blood and oxygen flow to the baby directly causes HIE. This interruption can be caused by several conditions or complications that arise during pregnancy or that occur during childbirth.
Causes of HIE During Pregnancy
- Fetal stroke
- Placenta blood flow problems
- Maternal cardiac disease
- Maternal Infections
Intrapartum Causes of HIE
- Placental abruption / bleeding
- Excessively low maternal blood pressure
- Umbilical cord complications
- Uterine rupture
What Are the Treatment Options for HIE?
When the brain is injured or damaged, it cannot simply be repaired with surgery or medications like other parts of the body. HIE is a permanent condition, and treatment options are generally limited to therapy and management. Babies born with HIE will often need life-long assistance and accommodations.
Malpractice Claims for HIE
In many situations, HIE results from medical negligence on the part of the OB/GYN and/or hospital. Doctors are not perfect and they are prone to professional mistakes like everyone else. This is particularly true in the field of obstetrics. OB/GYNs are sued for malpractice more than any other type of doctor. When complications arise during labor and delivery, doctors have a very limited time frame which leads to many mistakes in both judgment and skill. When a child is born with HIE because of medical negligence or error, the parents of that child have every right to seek financial compensation for that injury.
Can I See Recent HIE Settlements and Verdicts?
Below are summaries of recently reported settlements and verdicts in malpractice cases involving infant HIE. Every case is unique, and these summaries are provided for comparative purposes only.
- MINOR PLAINTIFF v. DEFENDANT (2020 – Virginia) – $2 million settlement: A baby suffered hypoxic-ischemic encephalopathy after he was born via a vacuum-assisted delivery. When labor was inducted, the first fetal heart rate strips were reassuring. However, it failed to progress and fetal heart strips were abnormal. The staff administered Cytotec and Pitocin. The mother’s uterine contraction patterns indicated persistent tachysystole. Near the end of labor, fetal heart rate showed a hypoxic risk. The obstetrician attempted a manual rotation. They then used a vacuum extractor and discovered shoulder dystocia. At birth, the baby was not breathing, lacked muscle tone, and experienced cyanosis. He experienced seizures after staff resuscitated him. The baby was then diagnosed with hypoxic-ischemic encephalopathy. This case settled for $2,000,000.
- PLAINTIFF V. DEFENDANT (2019 – Michigan) – $2.5 million settlement: A baby developed hypoxic-ischemic encephalopathy because of delays in the delivery. The hospital staff prolonged the second stage of labor. They attempted to resuscitate him a minute after his birth. His Apgar score was 3 at one minute and 9 at five minutes. Eighteen months later, he was diagnosed with a seizure disorder, developmental delays, and autism spectrum disorder. The expert neuroradiologist testified that the boy sustained hypoxic-ischemic encephalopathy hours before being born. He further testified that HIE caused his deficits. This case settled for $2,500,000.
- ZIOLKOWSKI v. ESCOBAR (2018 – Pennsylvania) – $7.2 million settlement: When a baby was born he needed emergency respiratory assistance but none of the doctors present in the delivery room were qualified in neonatal intubation techniques. The result was an 8-min delay before intubation, which interrupted blood and oxygen to the baby’s brain. The baby was diagnosed with HIE causing severe cerebral palsy. Just prior to trial parties agreed to settle for $7.2 million.
- DOE v. DEFENDANT HOSPITAL (2017 – Massachusetts) – $2.1 million settlement: Plaintiff alleged that doctors and hospital staff failed to properly monitor during the administration of Pitocin and did not realize that drug caused placental abruption. As a result, the baby suffered brain damage from hypoxic-ischemic encephalopathy. The case was settled for $2.1 million prior to trial.
- DOE v. AAA Corp. (2017 – Michigan) – $8 million settlement: Another case alleging negligent use of Pitocin to induce labor resulting in HIE. Plaintiff also alleged that doctors were negligent in their initial response to HIE after birth. HIE resulting in permanent disabilities to the entire left side of the child’s body.
These are just a few cases. But the settlement value of HIE case can be in the tens of millions of dollars. The calculus for determining the settlement value focuses on how severe the negligence was and how much future care the child will need.
Contact HIE Malpractice Lawyers at Miller & Zois
If you have a child born with HIE that may have resulted from medical negligence, contact the birth injury lawyers at Miller & Zois. We can investigate your case and determine whether you have a valid malpractice claim. Call us at 1.800.553.8082 or submit a request for a free consultation.