Hie Attorney in Houston

From the very first moment to our last, humans need to breathe. No matter what age you are, blood MUST circulate to deliver oxygen and nutrients to your cells and remove waste and toxic buildup. Without oxygen, your cells will die. If enough cells are affected, serious medical conditions, permanent brain damage or death can occur.

Although birth injuries happen in the earliest stages of life, they can result in damages that last for a lifetime. The expenses associated with long-term medical treatment for a birth injury are usually very extensive and can devastate the family’s finances.

If your child has sustained HIE or brain damage due to negligence, you may be entitled to compensation from the responsible party. However, you might understandably feel hesitant about pursuing litigation. Most hospitals and medical insurance companies are powerful entities with ample resources to employ highly-paid legal teams.

At Brown Trial Firm, we help even the playing field for patients by exclusively representing babies and their families. We’ll thoroughly investigate what happened. And if we believe the injury was avoidable and should have been prevented, then we will be ready to go up against even the largest hospital corporations or insurance companies. Years of devoted practice have instilled us with confidence, experience and the skills to match.

During pregnancy, labor and delivery, babies are especially vulnerable to lack of oxygen. During the vital perinatal period (the few weeks before, during and after birth), any interruption of oxygen to a baby’s developing brain is dangerous. Blood circulation is what supplies the body’s cells with oxygen for proper function.

There are 2 primary types of injuries caused by HIE:

1. Hypoxia/ischemia. Oxygen deprivation causes cells to starve and die.
2. Reperfusion injury. Oxygen deprived cells produce lactic acid and toxins. The lactic acid and toxins then re-circulate throughout the body via the bloodstream, causing additional harm.

Additionally, HIE can cause increased hyperactivity and attention disorders, and epilepsy. Other organs may be damaged, too, such as the heart, liver, kidneys and the central nervous system.

Severe cases of HIE may be identifiable immediately after delivery. However, sometimes HIE can go undetected until later, as the child grows older.

Before delivery

Out of the body’s entire oxygen supply, 20 percent is consumed by the brain. During pregnancy, the baby or “fetus” is not breathing with lungs. Instead, the mother’s placenta (an organ that develops and implants in the womb) and umbilical cord create a channel where blood circulates to and from the baby. Babies receive oxygen and nutrients, and also get rid of waste products and carbon dioxide, through the mother’s umbilical cord.

“Breathing” or gas exchange (i.e., oxygen for carbon dioxide) happens in the placenta itself in intervillous space. There, oxygenated blood from the mother diffuses into blood vessels in the placenta. The umbilical vein takes this blood to the baby.

The circulating blood bypasses the lungs and enters fetal circulation through special openings called “shunts.” The purpose of shunts is to bypass developing body parts (specifically, the lungs and liver).

The enriched blood comes through the umbilical cord and enters through a shunt near the baby’s liver called the “ductus venosus.” Some blood goes into the liver, but most travels on through the inferior vena cava into the right atrium of the heart. It’s then pumped out to the rest of the body in a “normal” circulatory pattern.

When the blood with waste products and carbon dioxide comes back to the heart, instead of being “oxygenated” by the baby’s own lungs, the waste is removed by 2 shunts—the foramen ovale (which bypasses the lungs) and the ductus arteriosus (which moves blood from the pulmonary vein to the aorta and on to the 2 umbilical arteries, back into the placenta for Mom to deal with).

During labor

After delivery

At birth, the doctor should carefully evaluate the baby’s condition and assign an Apgar score. The Apgar score is a subjective rating of the baby’s heart rate, skin color, reflexes, muscle tone and breathing effort. The doctor or nurse assigns a number from 0 to 2 for each item. The highest overall score is 10. A low Apgar score can indicate birth asphyxia.

An infant who has been deprived of blood flow and oxygen may have poor circulation, lethargy, abnormal breathing, blood-clotting abnormalities and lack of urine output. Physicians must act quickly to provide the proper treatment to help prevent further injury to the child.

What makes HIE so dangerous?

Sometimes the damage inflicted on a baby with HIE isn’t known quickly. This is because HIE can be difficult to diagnose when it occurs.

There are several reasons for this. A brain injury caused by HIE develops over a process. Blood pressure builds and oxygen is blocked from entering the brain. The brain cells begin to die and release toxic matter which will then damage other cells around them. HIE is dangerous because even if the cause of the injury is caught, this cycle of brain damage may continue for hours or even days.

Additionally, the extensive damage from HIE may not even be noticeable until developmental issues begin to occur later in the child’s life. There are many symptoms of HIE, but not all of them are extremely common or very apparent shortly after birth. A parent may notice that their child isn’t crawling or standing around the time they should be. Infants can be diagnosed with HIE as late as nine months after their birth.

Although tragic, the nature of HIE does provide some insight into how medical professionals must remain alert and follow the standard of care when delivering a baby.

What are the common causes of HIE?

Hypoxia or inadequate oxygen to the baby can result from a number of different known complications during pregnancy, labor and delivery.

For instance, during birth, HIE is possible through several different avenues: lack of oxygen, untreated jaundice, maternal infections, physical trauma and even low glucose levels. Lack of circulated oxygen can be the result of uterine contractions, compression or kinking of the umbilical cord, dangerous conditions such as uterine rupture or placental abruption, poor oxygen exchange or delivery from the mother to the baby through the placenta, as well as other conditions.

Here are some of the known causes of HIE:

Other potential causes of HIE include:

These are just a few examples of common complications that can occur during labor and delivery which cause hypoxia. Medical professionals must be well-trained to recognize these complications and to act quickly to protect the baby.

What are the symptoms of HIE during pregnancy?

One of the biggest symptoms of HIE during pregnancy involves fetal distress signals. These signals can usually be picked up by medical professionals during ultrasounds in virtually any trimester of pregnancy. A fetal distress signal is simply a movement or abnormal heart rate that a doctor can pick up on and treat accordingly.

Other signs and symptoms that doctors should take note of during pregnancy, especially a high-risk pregnancy, include:

The risk factors involved in a high-risk pregnancy vary. Some older women may be considered to have high-risk pregnancies. Women who have had previous birth complications or C-sections could also have high-risk pregnancies.

In the case of a high-risk pregnancy, a doctor will usually take special care to monitor both mother and baby throughout the entirety of the pregnancy.

It’s also worth noting that placental problems, such as placental abruption and placental insufficiency, can occur during pregnancy and during the birthing process. These conditions involve issues with the placenta dislodging from the uterine wall or a malformation of the placenta entirely. Again, in some cases, doctors may be able to pick up on this condition before it becomes a problem.

What are the symptoms of HIE immediately after birth?

Hypoxic-ischemic encephalopathy depends on 3 factors: the severity, timing and duration of the “insult” (cause of the injury). Some symptoms occur right away while others may not exhibit until later in life, making HIE difficult to diagnose.

Here are some signs that a baby is suffering from a neurological injury to the brain:

First 24 hours	Baby is not breathing or the baby’s heart is not beating at birth Not easily awakened or stimulated Apnea (temporary stops in breathing) Bradycardia (abnormally slow heartbeat) Eye responses may be intact, with or without spontaneous eye movements Hypotonia or low muscle tone (“floppy baby syndrome”) Jitteriness or seizures (some of them only detectable by EEG) Skin color may be “cyanotic” (blue) or very pale Moro, grasp, suck and swallow reflexes may be absent or “depressed” (reduced) Apgar score of less than 3 lasting longer than 5 minutes
12 – 24 hours	Apparent increase or decrease in the level of alertness Seizures Apnea Jitteriness and limb weakness Exaggerated Moro and deep tendon reflexes Shrill and monotonous cry
24 – 72 hours	Level of consciousness deteriorates Can experience respiratory arrest Seizures Signs of brainstem dysfunction (absent doll’s eyes, fixed or dilated pupils, etc.) Death

Mild hypoxic-ischemic encephalopathy may resolve. Moderate cases may or may not recover. Severe HIE cases often commonly result in:

• Stupor or coma (the infant may not respond to any physical stimulus except the most noxious)
• Irregular breathing and breathing support required
• Generalized hypotonia and depressed deep tendon reflexes
• Lack of neonatal reflexes (sucking, swallowing, grasping, Moro)
• Disturbances of eye motion
• Pupils that are dilated, fixed or poorly reactive to light
• Irregularities of heart rate and blood pressure, and death from cardiorespiratory failure

What are the symptoms of HIE during childhood?

Unfortunately, if an HIE diagnosis is not found within 24 hours of birth or suspicion of a brain injury is not followed up on, a child’s HIE may not be diagnosed until later in life. Because of the nature of HIE, major symptoms may not be very obvious immediately after birth.

Signs of HIE in infants and children include:

Cerebral palsy may be caused by HIE in some cases. Cerebral palsy can be diagnosed later on in development and treated accordingly.

HIE facts and statistics

• Approximately 20 per 1000 deliveries will require significant resuscitation, with biochemical and clinical evidence of perinatal asphyxia. Of these, only 1.6 per 1,000 will go on to develop signs of evolving encephalopathy consistent with hypoxic-ischaemic encephalopathy (HIE). This number is much higher in countries with limited resources.
• About 1-3 babies in 1,000 suffer an HIE injury at or near the time of birth. Approximately 15-20 percent of these babies with birth trauma will die after being born, and another 25 percent will have permanent injuries.
• Approximately 15-20 percent of infants are misclassified as having either a mild or no encephalopathy and are therefore not given treatment, which worsens their long-term prognosis.
• Birth asphyxia causes 23 percent of neonatal deaths worldwide.
• HIE is the fifth leading cause of death worldwide in children under 5 years of age, according to the World Health Organization.
• Among infants with moderate HIE, 10-20 percent develop minor neurological conditions, and 30-50 percent develop more serious complications.
• For infants with severe HIE, there is a 25-50 percent mortality rate. Deaths most often occur in the first few days after birth. Of babies that survive, roughly 80 percent develop serious complications.
• Approximately 30 percent of children with moderate-severe HIE develop cerebral palsy.
• Approximately 16 percent of children with moderate-severe HIE develop epilepsy.
• Approximately 14-17 percent of children with moderate-severe HIE experience blindness and 6 percent have hearing impairments.
• Hypothermia therapy should be started as soon as possible after the hypoxic-ischemic injury; current guidelines recommend that it begins within 6 hours of birth.

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737695/
https://www.medscape.com/answers/973501-106461/what-is-the-global-prevalence-of-hypoxic-ischemic-encephalopathy-hie
https://emedicine.medscape.com/article/973501-overview#a2

Medical Mistakes Can Cause HIE. Is HIE preventable?

Metabolic acidosis is detected by testing the baby’s blood. A sample is taken either from the umbilical cord or from the baby. The test then checks the pH and base of the baby’s blood for irregularities.

If your child was born with HIE, it may be due to a preventable medical error. Some errors that can result in HIE include:

• If your child was not timely delivered via C-section 
• If your child was not given hypothermia treatment

If you have questions about your child’s HIE diagnosis, we may be able to help you find answers.

CAN THE BRAIN RECOVER FROM A HYPOXIC BRAIN INJURY?

The prognosis for patients who suffer a hypoxic brain injury can be difficult to predict. While some patients may seem to make a full recovery, the full effects of a brain injury are often not known until sufficient time has passed to observe the patient.

In cases with infants, it can be especially difficult to know the full effects of a brain injury because sometimes the effects are not known until years later. Parents may have to wait years to see whether their child achieves normal developmental milestones, then seek additional screenings and tests, all before having a full picture of the child’s health.

Furthermore, obtaining an appropriate treatment plan can help patients manage short- and long-term conditions caused by hypoxic brain injuries. In this sense, many patients can eventually recover from a hypoxic brain injury.

How is HIE diagnosed and treated?

The APGAR score

APGAR stands for appearance, pulse, grimace, activity and respiration. This test is usually performed right after birth to evaluate the condition of the newborn.

The APGAR score takes into consideration paleness, heart rate, reflex responsiveness, overall muscle tone and breathing ability. Babies with HIE may exhibit pale or bluish skin, have a low heart rate and lack reflexes when tested. Some babies with HIE may also have little muscle tone and have problems breathing or crying after birth.

A very low APGAR score that does not improve in 5 minutes can lead to a diagnosis of HIE or possibly another birth injury condition. Unfortunately, given the subjectivity involved in the APGAR scoring system, HIE may not always be detected through this test.

The Sarnat clinical stages of HIE score

In 1976, Sarnat and Sarnat were working on developing a clinical ranking system to help improve the diagnosis of hypoxic-ischemic encephalopathy. These doctors proposed a 3-stage system for classifying HIE.

Laboratory tests, including those for arterial blood gas, coagulation system, cardiac and liver enzymes, renal (kidney) function and electrolyte levels, may be used to diagnose HIE. Neuroimaging through cranial ultrasonography (US), echocardiography and magnetic resonance imaging (MRI) is increasingly vital for early diagnosis. Of those 3, an MRI is probably considered the most valuable. Electroencephalograms (EEGs) may also be used to diagnose HIE since seizures are common. Hearing and eye exams may also be performed.

HIE treatment

Treatment for birth asphyxia depends on the severity. Babies born with mild asphyxia are provided with breathing support until they are breathing well on their own, and then monitored closely. Infants with more serious birth asphyxia may need a breathing machine, respiratory therapy and fluid and medications to prevent seizures and control blood pressure. Feedings may need to be delayed until the baby’s bowels recover.

Early intervention is vital.

Any type of fetal distress before, during or after birth should be handled swiftly by medical providers. When a baby isn’t getting enough oxygen, every minute matters. Doctors, nurses and midwives should know the signs that the baby isn’t getting enough oxygen and should be prepared to act quickly to protect the baby from injury and to prevent and mitigate brain injury and hypoxic-ischemic encephalopathy.

In cases of umbilical cord compression, prolapse or nuchal cord (when the cord is wrapped around the baby’s neck), the doctor may need to do a Cesarean section delivery to get the baby out quickly, getting him or her breathing as soon as possible. When the baby’s oxygen supply is diminished or cut off, it only takes minutes before long-term damage can occur.

Here are a few things that may help:

• Be aware of the risks associated with birth and delivery.
• Be observant during the birth process.
• Ask questions, and don’t be afraid to talk to the nurses and doctors about concerns.
• Insist on testing if anything seems off.
• If HIE is diagnosed, find out exactly what caused it.

Medical support provided to stabilize and treat HIE includes ventilation, perfusion blood pressure management (to prevent a “reperfusion injury” after the initial oxygen deprivation), fluid management, avoiding hypoglycemia and hyperglycemia, avoiding overheating, treating seizures and therapeutic hypothermia (~91°F for 72 hours).

Advanced treatment options for birth asphyxia include:

• High-frequency ventilation. This is a gentler form of mechanical ventilation that sends small puffs of air rapidly into the baby’s lungs. Unlike high-pressure conventional breathing machines, this type of breathing assistance is intended to protect a newborn’s fragile lungs from damage.
• Inhaled nitric oxide. This is used to treat respiratory failure and pulmonary hypertension (high blood pressure in the lungs). The nitric oxide goes directly into the windpipe through a breathing tube to help dilate blood vessels in the lungs so they can carry blood and oxygen to the body.
• Hypothermia. Cooling the infant’s internal body temperature to approximately 91 degrees Fahrenheit for up to 72 hours can help prevent brain damage during the second stage of asphyxia. This is the stage known as “reperfusion,” when normal blood flow and oxygen are restored to the brain. The treatment works best when started within 6 hours after birth. To qualify for hypothermia treatment, the infant must not be more than 4 weeks early.
• Extracorporeal membrane oxygenation (ECMO). A heart-lung pump may be used to provide temporary life support when the child’s heart and lungs are not functioning properly. The baby’s blood is drawn into a machine that adds oxygen, removes carbon dioxide and returns the oxygen-rich blood to the body. An infant on ECMO is sedated and closely monitored.

Glossary of common birth-related medical terms

• Anoxia: Complete lack of oxygen reaching the tissues (severe hypoxia).
• Asphyxia: Lack of total gas exchange (oxygen and carbon dioxide) causing suffocation.
• Encephalopathy: A disease, disorder or syndrome of overall effects on the function or structure of the brain.
• Hypercarbia (or hypercapnia): Elevated carbon dioxide levels in the blood.
• Hypothermia: Having a body temperature greatly below normal.
• Hypotonia: “Floppy baby syndrome” is a state of low muscle tone with very little flex or resistance in the muscles.
• Hypoxemia: Low oxygen in the blood.
• Hypoxia: Low oxygen in the tissues, representing a dangerous loss of oxygen to the brain or other body parts.
• Hypoxic-Ischemic (HI) brain injury: Injury due to hypoxia and/or ischemia (evidenced by biochemical, electrophysiological, neuroimaging or pathologic (postmortem) abnormalities).
• Hypoxic-Ischemic Encephalopathy (HIE): Encephalopathy with proof of damage specifically from a hypoxic and/or ischemic causes.
• Ischemia: Diminished/blocked blood flow to a part of the body.
• Neonatal encephalopathy: Clinical term that describes an irreversible injury-induced abnormal neurobehavioral state (decreased level of consciousness, signs of brain stem and/or motor dysfunction).
• Perinatal asphyxia: Condition during labor in which impaired gas exchange leads to fetal hypoxemia and hypercarbia.
• Perinatal/Neonatal depression: Condition of an infant within 1 hour of birth which includes depressed mental status, muscle hypotonia and possible disturbances in spontaneous respiration and cardiovascular function.
• Reperfusion injury: When blood flow/oxygen is recirculated into damaged cells, which causes them to release toxins that harm the tissues.
• Sequela: A medical condition or disorder that comes as a result of a previous injury or illness. From the Latin word meaning “that which follows, consequence.”

Contact an experienced and passionate HIE and birth injury attorney

If your child was hurt by HIE, you probably have a lot of questions. We can help you find answers, and help you understand your legal rights if a medical professional made a medical error when treating you or your baby. But don’t wait to act since the statute of limitations may bar your ability to bring a case if you wait too long.

Proper HIE treatment can be very costly, and not all medical or rehabilitation costs may be covered by medical insurance. Children who have suffered severe, irreversible brain damage due to hypoxia may require round-the-clock treatment and care. Our birth injury attorneys can help determine whether you are legally entitled to recover damages for negligent medical care. This vital legal compensation can help pay for medical bills, rehabilitation, therapy, expenses, lost earnings and physical pain and suffering.

At the Brown Trial Firm, we will fight to protect your child’s rights and ensure that you are fairly and fully compensated for your losses. If you would like to know if your child’s HIE was preventable, contact us to schedule your free case evaluation.