Hypoxic-Ischemic Encephalopathy (HIE)

A birth defect is an injury or other health issue that begins before delivery starts while the baby is still in the womb. A birth injury, meanwhile, occurs during labor, as the baby is born.

Birth defects are relatively common, with research showing that between 2% and 3% of all infants are born with defects. Genetics can cause some infections by the mom during pregnancy, or exposure to drugs through the mother while she is pregnant.

Meanwhile, about 7 in 1,000 children (or 0.7% of all newborn infants) experience birth injuries in the labor and delivery process. Physical pressure during the journey through the birth canal  usually causes these injuries, which in some cases results in nerve damage or broken bones.

While some minor injuries are often difficult to avoid, significant injuries can be the result of negligence by the medical professional.

When you hire an attorney, you’re getting their knowledge, experience, and reputation. Without that support, you’re fighting an uphill battle against insurance companies and their legal teams.

Hypoxic ischemic encephalopathy (HIE) is a type of birth injury that could threaten your infant’s life.  Decreased blood and oxygen flow to the infant’s brain, resulting in brain damage that could become chronic, leading to disability or even death.

In fact, studies have shown that between 40% and 60% of infants with an HIE birth injury either have severe disabilities or die by age 2.

As the nonprofit HIE Help Center points out, the full extent of the damage a child can experience from HIE is not always clear right after birth for two reasons:

When blood flow is cut off to parts of the brain, cells begin to break down, die, and release substances, which are toxic to other cells. These cells then begin to die off and continue the chain reaction, which causes brain injury to spread over a period of hours or days. Also, damage from HIE may occasionally not become apparent until a child has developmental delays.

For example, HIE can impact children’s mobility. However, those impacts are impossible to diagnose until an infant becomes mobile in the crawling and walking stages during their first year of life.

Because traumatic brain injuries are typically those resulting from a blow or jolt to the head, HIE is not always a traumatic brain injury. Its causes are more varied and can range from problems with the umbilical cord to low blood pressure in the mother.

However, many of the symptoms and consequences of HIE are similar to a traumatic brain injury because both can cause the death of brain cells and nerves. Both are significant issues for a newborn and can result in challenges and disabilities that last for years and even decades.

HIE and cerebral palsy are not the same, but an HIE birth injury can cause cerebral palsy. HIE is a brain injury that can cause both cognitive and physical disabilities, leading to brain damage that can impact motor signals to the rest of the body. Cerebral palsy (CP) is a group term for any disorder that affects a child’s ability to move and maintain balance.

According to the Centers for Disease Control and Prevention, different types of cerebral palsy can lead to stiff muscles, uncontrollable movements, or poor balance and coordination. Depending on which parts of the brain HIE affects, it can cause any of these types of CP, leading to significant motor issues in the children who have to experience it.

The lack of blood or oxygen flow to the brain that causes hypoxic ischemic encephalopathy can itself be traced to a few common causes. During pregnancy, problems with blood flow to the placenta, drug or alcohol abuse, and lung malformations can all lead to HIE as a birth defect long before labor begins. During labor and delivery, common causes include:

• Umbilical cord problems.
• Rupture of the uterus or abruption of the placenta.
• Excessive bleeding from the placenta.
• Abnormal fetal position, like the breech (legs first) position.
• Prolonged late stages of labor.
• Very low blood pressure in the mother.

The most common cause of HIE is the lack of blood flow or oxygen to the brain. That, in turn, is typically caused by some underdevelopment of the organs responsible for that blood flow, as well as any issues during the birthing progress that can cut off the flow of oxygen or blood.

Many of the causes of infant brain damage occur naturally. However, an HIE birth injury can also commonly be traced to medical negligence due to the failures of doctors, nurses, and other health providers:

• Doctors who treat pregnant mothers have to identify and properly address known risk factors for oxygen deprivation.
• During labor and delivery, proper care and fast responses to complications are critical, like performing a C-section in a timely fashion when recognizing that an infant is at risk.
• After birth, medical professionals need to promptly administer treatments to manage complications and medical conditions like a treatment known as “brain cooling.”

When medical providers fail to make these immediate adjustments, they can put the infant at a higher risk of HIE or worsening its effects.

One study estimates that neonatal HIE, which occurs during the birthing process, happens in approximately 1.5 to 2.5 of every 1,000 live births in developed countries. Because symptoms don’t always appear immediately, the exact number is difficult to narrow down.

Of course, these are still estimates that are generalized and don’t take individual situations into account. The risk for HIE increases significantly with medical error, especially when doctors and other healthcare providers don’t react quickly to some of the risk factors that can cause this birth injury.

Infants who suffer from HIE can show a variety of signs that alerts doctors, nurses, and even parents to the fact that something is wrong. The most common symptoms of hypoxic ischemic encephalopathy include:

• A lack of typical reflexes, especially as those reflexes develop after birth and in the first few months.
• Abnormal movements and, in severe birth injury cases, even seizures.
• Problems with breathing, including gasping and other movements that show a struggle to get oxygen.
• Decreased alertness and activity, especially in the first few months since babies should begin to recognize the world around them.
• Motor activity issues, both with fine motor skills (like grasping small items) and gross motor skills (like crawling and walking)

Not all these signs and symptoms necessarily appear as soon as the baby is born. They can gradually begin to surface as the baby gets the first pediatrician check-up. Talk to your pediatrician about the possibility of HIE if the infant misses some developmental milestones related to the above areas.

HIE is one of the leading causes of infant mortality in the United States. One study estimates that between 15% and 20% of infants diagnosed with HIE will pass away within the first week of being born. But those who survive are not safe yet. The same study also showed that of the surviving babies, around 25% will suffer permanent brain damage.

Some children, fortunately, can fully recover. They typically suffer from milder cases of HIE, which can cause stiff muscles and feeding problems but often dissipates within the first few weeks and months of life. Even in those mild cases, though, new parents can suffer through significant struggles while their newborn struggles to breathe and move.

While an HIE birth injury itself is not a disability, the health issues it can lead to for infants and small children can be. Common disabilities caused by hypoxic ischemic encephalopathy include:

• Learning disabilities.
• Brain bleeds.
• Seizures and epilepsy.
• Language disorders like speech delay.
• Behavioral and emotional disorders like autism, ADHD, and depression.
• Limitations in hearing and vision.
• Cerebral palsy.
• I/DD (intellectual and developmental disabilities).

These disabilities can arise from multiple causes, but typically originate in the brain, which is where HIE attacks.