Hypoxic ischemic encephalopathy (HIE) is brain injury caused by a lack of oxygen. The oxygen deprivation can be due to a lack of oxygen in the blood or a restriction of blood flow in the brain. In adults, heart attacks and strokes often cause HIE. In babies, HIE frequently is caused by a mismanaged complication during or near the time of delivery that deprives the baby of oxygen.
The most effective way to prevent permanent brain damage – or to reduce the severity of the damage – is to give the adult or baby hypothermia treatment. Brain or body cooling slows down almost every damaging event that occurs soon after the brain is deprived of oxygen. Babies with hypoxic ischemic encephalopathy can develop cerebral palsy, seizure disorders and other permanent conditions. Hypothermia has been shown to decrease the risk of cerebral palsy if given soon after an event that causes a lack of oxygen to the baby’s brain and HIE.
In babies, hypothermia treatment must be given within 6 hours of the oxygen depriving insult. The treatment lasts for 72 hours, and babies who were born at 36 weeks or later are eligible for the therapy. Since a diagnosis of hypoxic ischemic encephalopathy is required in order to be eligible for brain / body cooling treatment, it is critical that physicians promptly diagnose it so that treatment can be given within 6 hours of the insult. With babies, a diagnosis may be delayed because head imaging doesn’t show hypoxic / ischemic changes that soon after birth (although a brain bleed may be evident). This is why it is especially important for the medical team to pay close attention to a baby who had a traumatic birth (which includes having any abnormal (non-reassuring) fetal heart tones on the heart rate monitor) or whose mother had a high risk pregnancy.
SIGNS AND SYMPTOMS OF HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE)
The medical team should be on the lookout for indications that a baby might have hypoxic ischemic encephalopathy. Signs and symptoms of HIE may include the following:
- Low APGAR scores for longer than 5 minutes. An APGAR score tells physicians the likelihood that a baby will need medical intervention. It assigns scores to factors such as the baby’s skin color / complexion, pulse rate, reflexes, muscle tone, and breathing; it is one factor that assesses the newborn’s overall health.
- The baby needed resuscitation at birth or at any time during the neonatal period
- Seizures within the first 24 – 48 hours of delivery are an indication of HIE caused by an event during birth. Seizures while in the NICU or shortly after discharge from the NICU are an indication of an oxygen depriving insult that occurred after birth. The insult may have been sudden and severe, or it may have been long term oxygen deprivation. Long term oxygen deprivation can occur if the baby’s breathing isn’t properly managed (frequent apneic periods (baby stops breathing), anemia, etc.).
- Difficulty feeding, including inability to latch, suck or swallow
- Profound metabolic or mixed acidemia in an umbilical cord blood sample (the baby’s blood is acidic / has a low pH.)
- Hypotonia (low muscle tone)
- Abnormal limpness
- Multiple organ problems (e.g., involvement of the lungs, liver, heart, intestines)
- No brain stem reflexes (e.g., breathing problems and an abnormal response to light, and only blood pressure and heart function reflexes are functioning)
PHYSICAN PATENTS HYPOTHERMIA / BODY COOLING DEVICE AS A TREATMENT FOR HYPOXIC ISCHEMIC ENCEPHALOPATHY
A pediatric intensive care physician, Dr. Sergei Shushunov, recently patented a device that can give people, including newborns, hypothermia treatment through the breathing machine (ventilator). This is exciting news since 98% of people with HIE don’t receive needed hypothermia treatment. In the case of adults, treatment needs to be given more quickly than it does for babies. When people have heart attacks or strokes, they are usually at home and have to wait for an ambulance. By the time patients get through the chaotic emergency room and are admitted into the hospital, the time frame to give hypothermia treatment has passed. Using a ventilator to give cool air to someone suffering a heart attack or stroke would allow treatment to begin as soon as the patient is on the vent in the ER. Dr. Sergei Shushunov says that treatment could even begin in the ambulance through a portable ventilator or by using cool air when the patient is being bagged (receiving manual breaths from the health care provider through a mask and bag system).
Since many babies who have hypoxic ischemic encephalopathy (HIE) are mechanically ventilated, this seems like a good idea, although research is ongoing. Each time the baby gets a breath from the ventilator, the breath will be cold. Since the lungs have a very large surface area and are extremely vascular, this is an effective way to cool down the core body temperature and get cool blood to the brain. Currently, hypothermia treatment involves placing a baby on a cooling blanket or using a cool cap on the baby’s head. If a baby is already on a ventilator, cool air would be easy to deliver, and the blanket or cap would not have to be used. Caps can sometimes get in the way of EEG leads and other medical devices so using a ventilator could be very helpful for the baby.
HELP FOR CHILDREH WHO HAVE HYPOXIC ISCHEMIC ENCEPHALOPATHY, CEREBRAL PALSY OR ANY OTHER BIRTH INJURY
If your child underwent hypothermia treatment and now has a condition such as HIE, cerebral palsy, seizures or an intellectual disability, the medical team may have acted negligently. If your child has conditions such as HIE or cerebral palsy and hypothermia treatment was not given, this may also be negligent. Sometimes a diagnosis of HIE is made and hypothermia treatment is either improperly given or not given at all. Sometimes hypothermia treatment is properly given but the child still suffers from permanent brain damage. The nationally recognized firm of Reiter & Walsh ABC Law Centers has been helping children with birth injuries for over 25 years and has the skill and experience to carefully review medical records to determine if negligence occurred at any point and if the negligence caused the child’s injury.
Jesse Reiter, co-founder of ABC Law Centers, has spent his entire 25+ year career focusing on birth injury cases. Jesse helps children in Michigan and throughout the nation, and he spends a great deal of time getting to know the child and family he is helping so he can completely understand the child’s needs. Jesse has won many awards for his advocacy of children, and he is currently recognized as being one of the best medical malpractice attorneys in America by U.S. News and World Report 2014, as well as one of the 10 Best Attorneys in Michigan by Super Lawyers magazine. Reiter & Walsh ABC Law Centers is currently listed as being one of the best medical malpractice firms in the country by U.S. News and World Report 2014.
Birth injury is a difficult area of law to pursue due to the complex nature of the medical records. The award winning attorneys at Reiter & Walsh ABC Law Centers have decades of experience with birth injury and hypoxic ischemic encephalopathy (HIE) cases. To find out if you have a case, contact our nationally recognized firm to speak with an experienced attorney. We handle cases in Michigan, Ohio, Washington, D.C. and throughout the nation. We have numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call us at 888-419-2229.
In this video, Jesse discusses how a lack of oxygen in the baby’s brain can cause permanent brain injury such as cerebral palsy, hypoxic ischemic encephalopathy (HIE) and seizures. Jesse emphasizes the need for a very quick cesarean section (C-section) delivery when the baby is showing signs of distress during labor.