Hypoxic-Ischemic Encephalopathy (HIE) is a severe birth injury that can have lifelong consequences for your child and your family. At Miller & Zois, we understand the physical, emotional, and financial challenges that come with caring for a child affected by HIE. Our dedicated medical malpractice attorneys are here to provide the support and guidance you need to navigate the complex legal process involved in HIE birth injury lawsuits. With our expertise, we’ll work tirelessly to ensure that you receive the compensation you deserve for the medical negligence that led to your child’s injury.
What is Hypoxic-Ischemic Encephalopathy (HIE)?
Hypoxic-Ischemic Encephalopathy (HIE) is a type of brain injury that occurs when a newborn’s brain does not receive enough oxygen and blood flow during the birthing process. This deprivation of oxygen and nutrients can lead to severe brain damage, resulting in a wide range of long-term developmental, cognitive, and physical disabilities. In some cases, HIE can be fatal.
HIE is often caused by complications with the umbilical cord, uterine tearing, and blood circulation problems in the placenta. Hypothermia (cooling) is the only available treatment for HIE, which involves reducing the infant’s body temperature to lower the metabolic rate and decrease inflammation in the brain.
The full extent of damage from HIE is often not immediately apparent due to the evolving nature of brain injury and the potential for developmental delays to reveal the impacts later on. There is no cure for HIE, but various treatments and therapies can meaningfully improve symptoms and functionality in affected children.
What Happens When a Child Suffers from HIE?
HIE occurs when there isn’t enough blood flow or glucose (sugar) reaching the brain. This lack of resources causes a decrease in the production of adenosine triphosphate (ATP), an essential molecule that provides energy to cells. Consequently, the sodium-potassium pumps, which help maintain the balance of ions in cells, stop working correctly, leading to the death of brain cells, or neurons.
This problem doesn’t just harm the neurons but also causes them to become depolarized. Depolarization makes neurons release neurotransmitters, which can make the damage worse in a few ways.
First, these neurotransmitters can activate other processes, like creating free radicals and more excitatory neurotransmitters. Free radicals can cause oxidative stress and further damage neurons.
Second, the release of neurotransmitters can lead to cortical irritability or trigger seizures. Seizures can make brain injuries worse because they increase the brain’s energy needs and may intensify the imbalance between oxygen and glucose supply and demand.
The development of HIE is complex and involves many factors, such as reduced blood flow, glucose supply, ATP production, sodium-potassium pump failure, and neuronal depolarization. All these events lead to brain cell injury, the creation of free radicals, and seizures, which contribute to the severity of HIE and its long-term effects.
Severity of HIE – Sarnat Staging
The severity of a child’s HIE is diagnosed through brain imaging techniques like ultrasound and MRI and blood gas tests to determine blood pH levels. The severity of HIE is determined using Sarnat staging, which considers clinical presentation, exam results, seizure presence, and illness duration.
Sarnat staging is a widely used clinical classification system for determining the severity of hypoxic-ischemic encephalopathy (HIE) in newborns. Developed by Drs. Gerald Sarnat and Martin Sarnat in 1976, this staging system takes into account a combination of clinical presentation, examination results, seizure presence, and illness duration. The classification helps medical professionals assess the degree of brain injury, predict potential outcomes, and guide treatment plans.
Sarnat Staging Grades
Sarnat staging consists of three grades, with Grade I being the mildest and Grade III the most severe:
- Sarnat Grade I (Mild HIE): In mild HIE, the clinical presentation may include the following characteristics:
- Slightly altered level of consciousness, such as mild lethargy
- Normal or slightly increased muscle tone
- Mild or no seizures
- A relatively normal EEG (electroencephalogram) or slightly abnormal patterns
- Illness duration of less than 24 hours
Babies with mild HIE generally have a favorable prognosis, and the risk of long-term neurological complications is low.
- Sarnat Grade II (Moderate HIE): Moderate HIE is characterized by the following:
- Markedly altered level of consciousness, such as lethargy or stupor
- Moderate hypotonia (decreased muscle tone) or hypertonia (increased muscle tone)
- Seizures, which are more frequent and severe compared to Grade I
- EEG showing significant abnormalities or a burst-suppression pattern
- Illness duration of 24-48 hours
In moderate HIE, there is an increased risk of long-term neurological complications, such as cerebral palsy, cognitive impairments, or epilepsy.
- Sarnat Grade III (Severe HIE): Severe HIE is associated with the following features:
- Severely altered level of consciousness, such as coma or deep stupor
- Severe hypotonia or flaccidity
- Frequent, severe, and difficult-to-control seizures
- EEG showing severe abnormalities or an isoelectric (flat) pattern
- Illness duration of more than 48 hours
Babies with severe HIE have a high risk of significant long-term neurological complications, including severe cerebral palsy, profound cognitive impairments, and epilepsy. There is also an increased risk of mortality in this group.
Organs Impacted by HIE
Hypoxic-ischemic encephalopathy (HIE) primarily affects the brain, but it can also lead to multiorgan failure due to the systemic nature of oxygen deprivation and reduced blood flow. When the brain is deprived of oxygen, the body may prioritize preserving brain function by diverting blood flow from other organs to the brain. This redirection can have detrimental consequences on various organs, leading to multiorgan failure.
Paradoxically, with acute profound HIE, there is less risk to other organs. Multiorgan failure is less likely to occur due to the limited time frame for the body to compromise other organs in an attempt to protect the brain. Conversely, in a partial-prolonged HIE scenario, the brain has redirected blood and oxygen flow from other organs to itself over an extended period, resulting in the potential for multiorgan failure.
Seizures and HIE
HIE, or hypoxic-ischemic encephalopathy, can indeed lead to seizures. Typically, the seizures experienced by children with HIE are relatively manageable and can be brought under control with appropriate treatment. However, there are cases where children with severe HIE may develop a more challenging condition called status epilepticus.
Status epilepticus refers to a prolonged seizure or a series of seizures without a complete recovery of consciousness between episodes. This condition is more commonly found in children with severe HIE and is not typically observed in cases with less severe, or refractory, HIE. Seizures in HIE can be caused by the brain’s increased irritability due to the release of neurotransmitters and the disruption of normal brain function. Uncontrolled seizures are a serious issue in newborns with HIE and they have been linked to brain damage and poor developmental outcomes.
Managing seizures is crucial for children with HIE, as uncontrolled seizures can worsen the brain injury and lead to further complications. Treatment options for seizures in HIE may include anti-seizure medications, such as benzodiazepines or antiepileptic drugs. But drugs are tricky with HIE-related seizures. Current medications for treating seizures, such as phenobarbital and phenytoin, aren’t always effective and may even have harmful effects on a developing brain. A newer medication called levetiracetam might have fewer risks, but its effectiveness is still being evaluated.
Causes of HIE
Hypoxic-ischemic encephalopathy (HIE) is a condition that occurs when the brain doesn’t receive enough oxygen and blood flow, which can lead to brain damage. There are various causes of HIE, including:
- Complications during childbirth: HIE can occur when there are complications during labor and delivery, such as a prolapsed umbilical cord or problems with the placenta. One reoccurring problem is the umbilical cord becoming compressed, knotted, or wrapped around the baby’s neck, restricting blood flow and oxygen supply.
- Maternal health problems: Health problems affecting the mother during pregnancy, such as hypertension or placental insufficiency, can also lead to HIE. This is why high-risk pregnancies must be treated differently.
- Trauma: Trauma to the head or oxygen deprivation due to drowning, suffocation, or strangulation can cause HIE.
- Infections: Infections such as meningitis, sepsis, and encephalitis can also lead to HIE.
- Inadequate fetal monitoring: Failure to accurately monitor the baby’s heart rate and other vital signs during labor, leading to delayed intervention in the case of complications.
- Delayed C-section: A delayed decision to perform a cesarean section when it becomes clear that a vaginal birth is not possible or safe for the baby.
- Uterine rupture: A tear in the uterine wall that can lead to severe bleeding and reduced oxygen delivery to the baby.
The severity of HIE can vary depending on the cause and the extent of the brain damage. It’s important to identify and address the underlying cause of HIE as soon as possible to prevent further damage and minimize long-term effects. Some HIE malpractice lawsuits are more about reacting to a known problem than filing to diagnose complications.
When Medical Negligence Leads to HIE
In some cases, HIE is unavoidable, but in many others, it results from medical negligence. Healthcare providers have a duty to adhere to the standard of care during pregnancy, labor, and delivery. If they fail to do so and their negligence leads to an HIE birth injury, they may be held liable for the damages incurred.
Examples of medical negligence that can cause HIE include:
- Misinterpretation of fetal monitoring: A failure to recognize signs of fetal distress and take appropriate action.
- Inadequate or delayed intervention: A healthcare provider’s failure to respond to complications promptly and effectively.
- Improper use of labor-inducing drugs: Overuse or misuse of drugs like Pitocin, which can lead to dangerous contractions and oxygen deprivation.
- Inappropriate use of delivery tools: Forceps or vacuum extractors can cause injury if used incorrectly or in situations where their use is not warranted.
- Failure to diagnose and treat maternal infections: Infections can be passed on to the baby, leading to oxygen deprivation and HIE.
HIE Malpractice Settlements and Verdicts
Below are settlements and verdicts from recent birth injury malpractice cases involving HIE. Keep in mind these are not meant to be representative of the average HIE settlement value, but rather just a tool for comparative analysis.
$8,000,000 Settlement (Michigan 2024): The plaintiff, a 29-year-old woman with well-managed gestational diabetes, delivered a healthy baby boy at nearly 39 weeks. The baby seemed fine. During postnatal recovery, a nurse discovered that he had stopped breathing approximately an hour and a half after birth. The baby was diagnosed with HIE from the oxygen deprivation to the brain. The family filed an HIE birth injury lawsuit that argued that the critical period immediately after birth was not properly supervised by the attending nurse, leading to the newborn’s sudden respiratory arrest and subsequent HIE. As a result of the HIE, the baby was diagnosed with cerebral palsy and severe cognitive and developmental impairments, necessitating lifelong specialized care and a feeding tube for nourishment. The lawsuit settled when the doctors made an $8 million settlement offer.
$11,ooo,ooo Verdict (Illinois 2023): A mother-to-be was struggling to bring her child into the world with a child whose fetal heart rate should have signaled the child needed to be delivered. Despite these alarming signs, the obstetrician in charge made the decision to wait for a natural birth instead of performing a Cesarean section. As the minutes ticked by, the baby boy endured a 30-minute delay in his delivery. This precious time loss exposed him to ongoing hypoxic-ischemic injuries, ultimately resulting in brain damage.
$35,182,818 Verdict (New York 2023): A mother who was 9 months pregnant fell on her abdomen and went to the hospital. She was told everything was fine and discharged. She saw her OB/GYN 2 more times over the following few days before she had to be rushed to the hospital for an emergency C-section delivery, at which time it was discovered that she had suffered a placental abruption from the fall. The baby suffered an HIE injury and was left blind and severely disabled for the rest of her life. The lawsuit accused the defendants of negligently failing to diagnose and treat the mother’s placental abruption. The verdict included $2.1 million in future economic damages and the rest for pain and suffering.
$500,000 Settlement (Kansas 2022): The defendant doctor attempted to use a vacuum extractor to assist with difficult vaginal delivery. The effort was not successful and in the process, the vacuum device caused significant trauma to the baby’s head. The baby had to be resuscitated after delivery and was transported to a NICU where he was diagnosed with a large subgaleal hemorrhage and hypoxic-ischemic encephalopathy. The baby died 3 days later. The mother’s lawsuit alleged that the doctor was negligent in his use of the vacuum extractor and that negligence was the cause of the baby’s death.
$1,000,000 Settlement (New York 2022): During labor and delivery at St. Luke’s Cornwall Hospital shoulder dystocia was encountered causing the baby to become stuck in the birth canal for an extended time period. The baby lost oxygen and was suffered hypoxic-ischemic encephalopathy resulting in gross and fine motor disabilities. The lawsuit alleged that the doctors were negligent in failing recognize signs of fetal distress and execute a C-section in a timely manner.
$7,000,000 Settlement (Illinois 2021): Infant reportedly suffered permanent and disabling injuries, including hypoxic-ischemic encephalopathy, during his birth at VHS West Suburban Medical Center, where his mother presented for labor and delivery at 36.5 weeks gestational age with a diagnosis of spontaneous rupture of membranes. The lawsuit alleged that the defendants were negligent in failing to properly monitor the mother and failing to determine that the baby had been expelled spontaneously without a healthcare professional in the room and became trapped under the mother’s right thigh.
$6,000,000 Settlement (Michigan 2021): Infant was born with HIE leading to cerebral palsy and permanent cognitive impairment requiring lifelong assistance due to oxygen deprivation during childbirth. The lawsuit alleged that the defendant (a federally run hospital) was negligent in failing to order a C-section despite signs of uteroplacental insufficiency, maternal hypotension and non-reassuring fetal status.
Contact Our Birth Injury Lawyers
If you want to investigate your potential child injury claim or if you are a lawyer looking for help evaluating your client’s claim, call our birth injury malpractice lawyers at 800-553-8082.