California is home to some of the nation’s leading health care facilities and medical professionals, making it a state where many residents have access to top-tier medical care. And there’s even more great news for parents looking to start a family:
With an infant mortality rate of 4.07 per 1,000 live births in 2021, California’s infant mortality rate has been declining in recent years and is significantly below the U.S. average of 5.4. This points to an overall positive trend in California of increased maternal and infant health.
Unfortunately, despite these positive signs, birth injuries like hypoxic-ischemic encephalopathy (HIE) continue to affect thousands of infants across California and the U.S. every year. This condition, caused by reduced oxygen and blood flow to a newborn’s brain, can result in severe, long-lasting effects that can significantly impact both a child’s and their family’s lives.
If your child is suffering from HIE, you probably have a lot of concerns and unanswered questions:
- How will HIE affect my child’s education and social development?
- Will my child be able to have a “normal” life?
- How am I going to pay for all their medical treatments and therapies?
- Did a medical mistake during delivery cause my child’s HIE?
At Brown Trial Firm, experienced California HIE attorney Laura Brown understands the emotional weight and financial stress that a birth injury can place on a family, but please know that you’re not alone and help is available.
Laura has years of experience in birth injury law and can use that expertise to guide you through this challenging time so you can take the necessary steps to protect your child’s well-being.
Don’t wait to get the answers and compensation your child needs.
Contact Brown Trial Firm today for a free consultation to learn about your legal options for financial recovery.
What is hypoxic-ischemic encephalopathy (HIE)?
Hypoxic-ischemic encephalopathy (HIE) is a type of brain damage that occurs when an infant’s brain doesn’t receive enough oxygen and blood.
The term “hypoxic” refers to insufficient oxygen, “ischemic” refers to insufficient blood flow, and “encephalopathy” refers to a condition that affects the brain.
HIE can occur before, during or after birth and is a serious medical issue that requires immediate attention and intervention.
What are the symptoms of HIE?
The symptoms of HIE can vary depending on the severity of the condition and the specific areas of the brain affected but may include:
- Low Apgar score. This is a test given to newborns shortly after birth to evaluate their physical condition. A low Apgar score can indicate a problem such as HIE.
- Difficulty breathing or absence of breathing. Respiratory distress is a common sign, often requiring immediate intervention like mechanical ventilation.
- Seizures. Electrical disturbances in the brain can lead to convulsions or other seizure activity, which is often a red flag for neurological issues like HIE.
- Poor muscle tone. Infants with HIE may display abnormal muscle tone, appearing either too floppy or too rigid.
- Feeding difficulties. Sucking and swallowing may be compromised in infants with HIE, leading to feeding difficulties.
- Lethargy or lack of responsiveness. Affected infants may be abnormally sleepy, have difficulty waking up, or not respond to stimuli in the way that a healthy newborn would.
- Abnormal heart rate. Infants with HIE may have heart rates that are either too fast (tachycardia) or too slow (bradycardia), indicating possible distress or inadequate oxygen supply to the brain.
- Bluish or pale skin color. This indicates poor oxygen circulation and is a cause for immediate concern.
- Low or high blood sugar. Abnormal glucose (blood sugar) levels can be a sign of metabolic stress and are often monitored in suspected cases of HIE.
- Acidosis. Elevated levels of acid in the blood, usually checked through arterial blood gas tests, may indicate a lack of oxygen and HIE.
- Trouble hearing. Infants with HIE may not respond to auditory stimuli, such as voices or sounds, in a manner typical for their developmental stage.
- Organ failure. In cases of severe HIE, there may be signs of organ failure, including jaundice, edema or other signs indicative of organ dysfunction, requiring urgent medical attention.
Please note that immediate medical evaluation and treatment are essential if any of these symptoms are observed.
What are signs of HIE in older babies and toddlers?
Hypoxic-ischemic encephalopathy is not always immediately apparent, especially in less severe cases. In fact, some children may not begin to show signs of HIE for weeks or even months after birth. As these children grow, signs and symptoms of HIE typically become more evident, particularly in the areas of motor skills, cognitive function and sensory perception.
Below are some common signs that may suggest an older infant or young child is suffering from HIE:
- Delayed fine and gross motor skills like crawling, walking or gripping objects
- Delayed speech or trouble with language comprehension
- Excessive crying or irritability
- Learning disabilities
- Problems with senses like sight or hearing
- Ongoing issues with seizures
- Impaired coordination and balance
- Difficulty with chewing or swallowing or a general disinterest in eating
- Slowed or delayed physical growth
- Difficulties with social interactions, forming relationships or understanding social cues
If you suspect that your child is showing signs of HIE, it is essential to consult a health care provider for a comprehensive evaluation. Early diagnosis and intervention can be critical in mitigating the long-term impacts of HIE.
What causes HIE in infants?
HIE is a type of brain damage that occurs when an infant’s brain doesn’t receive enough oxygen and blood either before birth or during labor and delivery.
Causes of HIE before birth
- Maternal infections. Infections in the mother, such as chorioamnionitis, can cause inflammation and impact fetal oxygen levels.
- Preeclampsia. High blood pressure in the mother can reduce blood flow to the placenta and, in turn, to the fetus.
- Congenital abnormalities. Structural defects in the heart or lungs can impair oxygenation.
- Umbilical cord issues. Problems like a prolapsed or compressed umbilical cord can restrict blood flow to the fetus.
- Placental insufficiency. When the placenta isn’t functioning properly, it can lead to decreased oxygen, nutrients and blood flow to the fetus.
- Fetal anemia. Low levels of red blood cells in the fetus can limit oxygen-carrying capacity.
Causes of HIE during labor and delivery
- Meconium aspiration. If a baby inhales meconium (fecal matter) during delivery, it can lead to respiratory problems and low oxygen levels.
- Shoulder dystocia. This is when the baby’s head passes through the birth canal, but the shoulders get stuck, causing a delay in birth and potential oxygen deprivation.
- Breech delivery. This is where the baby’s feet or buttocks enter the birth canal first instead of the head, which can cause complications such as umbilical cord compression or entanglement and lead to reduced oxygen supply to the baby’s brain.
- Uterine hyperstimulation. This happens when there are excessively frequent or prolonged contractions, which can impair the flow of oxygen to the baby, potentially leading to HIE. This is often the result of too much Pitocin during labor.
- Uterine rupture. This is a rare but severe complication where the uterine wall tears, posing immediate risks to both mother and baby, including the potential for HIE due to oxygen deprivation.
- Kernicterus. Untreated jaundice in newborns can lead to a condition known as kernicterus, a type of brain damage that occurs when bilirubin, a yellow substance formed during the normal breakdown of red blood cells, accumulates at high levels in the blood. This can result in oxygen deprivation to the brain and may contribute to HIE.
- Operative delivery complications. Problems during a cesarean section (C-section) or the use of forceps or vacuum extraction can cause trauma and oxygen deprivation.
- Prolonged labor. An extended or difficult labor can put stress on the baby, leading to reduced oxygen levels.
- Umbilical cord accidents. Issues like umbilical cord prolapse or a knot in the cord can cut off the baby’s oxygen supply abruptly during labor and delivery.
- Inadequate fetal monitoring. Failure to correctly monitor fetal distress signs can delay necessary interventions that could prevent oxygen deprivation and HIE.
Understanding these causes is crucial for medical professionals to prevent and appropriately manage HIE. If signs of HIE are recognized, immediate intervention is critical to mitigate long-term damage and complications.
It’s important to note that while some instances of HIE can’t be prevented, others caused by the negligence of a medical professional may be considered medical malpractice.
What are the long-term effects of HIE?
The long-term effects of HIE can vary depending on the severity of the condition and the timing of medical intervention, but they often significantly impact a child’s overall quality of life and may require ongoing medical care, educational support, and potentially lifelong interventions, contributing to emotional and financial strain on families.
- Cerebral palsy is common among children with HIE, affecting motor skills and muscle coordination. Children with cerebral palsy may experience difficulties with movement, posture and muscle tone, requiring lifelong therapy and assistive devices for mobility.
- Epilepsy is another potential long-term outcome of HIE, characterized by recurrent seizures that can severely impact quality of life. Effective management often involves medication and sometimes surgical intervention to control seizure activity.
- Neuropathic pain can emerge as a long-term effect of HIE and involves chronic pain stemming from damage to the nervous system. This type of pain is often challenging to manage and may require a combination of pharmacological and non-pharmacological treatments.
- Attention deficit hyperactivity disorder (ADHD) could be a long-term effect of HIE, affecting a child’s concentration, impulsivity, and overall behavior. This condition may require ongoing medical treatment and behavioral therapy to manage symptoms and improve quality of life.
- Autism spectrum disorder may also be a long-term consequence of HIE, impacting social interactions, communication and behavior. The disorder varies in severity and may necessitate specialized educational and behavioral interventions to help the individual lead a fulfilling life.
Cognitive and developmental delays
- Learning disabilities may be a long-term consequence of HIE, affecting a child’s ability to process, understand and use information. These challenges can impact academic performance and may require specialized educational support and interventions.
- Speech delays can occur as a long-term effect of HIE, potentially hampering the child’s ability to communicate effectively. This can lead to social difficulties and may necessitate speech therapy for improvement.
- Hearing loss associated with HIE can affect a child’s language development and ability to interact with their environment. Early intervention with hearing aids or cochlear implants may be required to support developmental milestones.
- Visual impairment may occur as a long-term consequence of HIE, affecting a child’s ability to navigate the world and hindering academic progress. Depending on the severity, this may require specialized educational interventions and assistive technologies.
- Respiratory problems can be a long-term effect of HIE, potentially leading to conditions like chronic lung disease or asthma. These issues may require ongoing medical treatment and can impact the individual’s quality of life.
- Gastrointestinal issues can also be a long-term consequence of HIE, manifesting as chronic constipation, diarrhea or gastroesophageal reflux disease (GERD). These conditions may necessitate dietary modifications and ongoing medical care.
- Growth delays may be another long-term effect of HIE, affecting a child’s physical development and potentially requiring specialized medical and nutritional intervention. Monitoring and treatment are usually needed to help the child reach developmental milestones.
- Limited mobility is another potential long-term effect of HIE that can severely impact a child’s daily life and independence. This limitation can make even simple tasks difficult, necessitating assistive devices like wheelchairs or crutches, and may require ongoing occupational therapy and other interventions.
For years, California HIE attorney Laura Brown has been helping her clients get results like these:
HIE & cerebral palsy birth injury
The child’s HIE and CP were caused by hypoxia and ischemia when the umbilical cord wrapped around the child’s neck, preventing the child from getting enough oxygen. The medical providers did not identify the warning signs and did not order a timely c-section. The delay caused severe and permanent injuries.
Understanding the range of possible long-term effects is crucial for early intervention and management, which can greatly improve outcomes and quality of life for affected individuals.
What is the survival rate of severe HIE?
The survival rate for severe HIE can vary widely depending on multiple factors, including the quality and promptness of medical care, the degree of oxygen deprivation, and a child’s overall health.
Although estimated mortality rates generally range anywhere from 10 to 60%, recent studies published in PLOS One and the National Library of Medicine estimate the mortality rate of infants with HIE to be 25.3% and 26%, respectively, meaning that the majority of infants with HIE (around 75%) survive.
What treatment is available for children with HIE?
The immediate treatment for HIE is aimed at preventing further brain damage and primarily involves therapeutic hypothermia. This treatment must begin as soon as possible after diagnosis, ideally within the first 6 hours after birth, to be most effective.
During this treatment, known as hypothermic brain cooling, the baby’s body temperature is lowered to approximately 33.5°C (92.3°F) for about 72 hours. Cooling the body reduces the metabolic rate and slows the processes that lead to cell death, thus minimizing potential brain damage.
Recent California clinical trial results for new HIE treatment
A 2022 clinical trial led by the University of California, San Francisco (UCSF) found that a promising secondary therapy for hypoxic-ischemic encephalopathy may not be as effective as originally hoped. The therapy in question is the neuroprotective agent erythropoietin, which was tested in conjunction with cooling therapy, the only current treatment proven to reduce the risk of death or long-term disability from HIE.
The trial revealed that combining erythropoietin with cooling therapy did not improve outcomes for newborns with HIE and slightly increased the chance of complications. The findings challenge the current use of erythropoietin in some hospitals and underscore the importance of large clinical trials in understanding the effectiveness of treatments for conditions like HIE.
Researchers are now questioning whether erythropoietin alone could be beneficial in low- and middle-income countries where cooling therapy is often unavailable.
When is HIE the result of a medical mistake?
Medical negligence can be a significant factor in the occurrence of HIE. Inappropriate actions, omissions or delayed interventions by doctors and other health care professionals during prenatal care, labor and delivery can lead to oxygen deprivation or reduced blood flow to the baby’s brain.
- Failure to provide adequate prenatal care and testing
- Failure to recognize or appropriately respond to fetal distress
- Improper use of delivery instruments
- Failure to perform an emergency C-section when medically indicated
- Failure to adequately monitor the baby’s heart rate and vital signs
- Failure to diagnose, treat or appropriately manage placental problems, umbilical cord problems, infections or jaundice
- Failure to recognize or appropriately manage fetal malposition during delivery
If you suspect that medical negligence contributed to HIE in your child, consider consulting an experienced birth injury attorney as soon as possible, as there are time limits to file a claim and recover compensation.
Do babies with HIE cry a lot?
Babies with HIE may or may not cry excessively, depending on the severity and extent of their brain injuries. It’s important to note that crying patterns can vary widely among newborns and may not be a definitive indicator of HIE.
Excessive crying could be related to various other factors, such as colic, gastrointestinal issues or general discomfort. However, if a baby with known or suspected HIE cries excessively, it may be indicative of underlying neurological or physiological problems. Any such symptom should be evaluated immediately by health care professionals to determine its cause and implement appropriate interventions.
Can a baby fully recover from HIE?
The possibility of a full recovery from HIE varies widely depending on the severity of the condition, the timing of the intervention, and the overall health of the infant. In milder cases of HIE, timely and appropriate treatment like therapeutic hypothermia can minimize brain damage and improve the chances for a more complete recovery.
However, in moderate to severe cases, the likelihood of long-term complications such as cognitive impairments, developmental delays, and motor disabilities is higher. It’s crucial to consult health care professionals for a thorough assessment and treatment plan tailored to the child’s specific condition and symptoms.
Can someone with HIE live a normal life?
The ability for someone with HIE to live a “normal” life can vary significantly depending on a multitude of factors, including the severity of the initial injury, how quickly treatment was administered, and the kinds of long-term care and therapies that are available to the child as they grow.
Mild cases of HIE may result in fewer complications, and with timely and appropriate interventions, some children may go on to live lives that are largely unaffected by the condition.
However, for those with moderate to severe HIE, the risk of long-term neurological and developmental issues is higher, which could necessitate lifelong therapies and treatments. Even with these challenges, many individuals with HIE can achieve a fulfilling quality of life with the right support and resources.
Can autism be caused by HIE?
The relationship between hypoxic-ischemic encephalopathy and autism is not entirely understood and remains a topic of ongoing research. While HIE is a condition resulting from a lack of oxygen to the brain, its direct link to the development of autism is not definitively established.
However, HIE is known to cause neurological damage, and some studies have suggested that children who experience brain injuries like HIE may have an increased risk of developing conditions that affect neurological and developmental health, including autism.
Are you worried your baby’s HIE was the result of a medical mistake? Contact experienced California HIE attorney Laura Brown for a free consultation.
At Brown Trial Firm, California HIE attorney Laura Brown understands the immense stress new parents face when trying to secure the necessary help for a child affected by hypoxic-ischemic encephalopathy. That’s why she and her team are committed to offering the compassionate guidance you need during this challenging time.
When you schedule a free consultation with Brown Trial Firm, Laura will evaluate your child’s medical records and consult with medical experts to help determine whether you have a viable case.
If she believes medical negligence led to your child’s birth injury, she can then guide you through the complex legal process to help you secure compensation for economic damages like medical bills and long-term care, as well as non-economic damages like pain and suffering, emotional distress and loss of enjoyment of life.
Don’t wait to get your child the financial help they need to live their life to the fullest. Contact Brown Trial Firm today to get started.
Fellow attorney, handling an HIE case and seeking birth injury expertise?
At Brown Trial Firm, Laura Brown stands out as a dedicated specialist in HIE cases with a track record of success nationwide. Recognizing the intricacies and challenges of HIE litigation, Laura and her team have honed their skills to provide unparalleled representation.
When you partner with Brown Trial Firm, you’re not just getting a co-counsel; you’re gaining an ally with deep expertise in HIE, access to top medical experts, and a commitment to achieving the best possible outcome for the families affected.
Ensure your clients receive the best representation and increase the chances of a favorable verdict.
Partner with Laura Brown today.
California. (2020, May 19). www.cdc.gov. https://www.cdc.gov/nchs/pressroom/states/california/ca.htm
CDC. (2019, March 27). Infant Mortality | Maternal and Infant Health | Reproductive Health | CDC. www.cdc.gov. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm#:~:text=About%20Infant%20Mortality
Ezenwa, B. N., Olorunfemi, G., Fajolu, I., Adeniyi, T., Oleolo-Ayodeji, K., Kene-Udemezue, B., Olamijulo, J. A., & Ezeaka, C. (2021). Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study. PLOS ONE, 16(4), e0250633. https://doi.org/10.1371/journal.pone.0250633
Namusoke, H., Nannyonga, M. M., Ssebunya, R., Nakibuuka, V. K., & Mworozi, E. (2018). Incidence and short term outcomes of neonates with hypoxic ischemic encephalopathy in a Peri Urban teaching hospital, Uganda: a prospective cohort study. Maternal Health, Neonatology and Perinatology, 4(1). https://doi.org/10.1186/s40748-018-0074-4
UCSF-Led Clinical Trial Shows Complexity of Improving Birth Asphyxia Treatment | Department of Pediatrics. (n.d.). Pediatrics.ucsf.edu. Retrieved October 9, 2023, from https://pediatrics.ucsf.edu/news/ucsf-led-clinical-trial-shows-complexity-improving-birth-asphyxia-treatment