Florida HIE Lawyers

Hypoxic-Ischemic Encephalopathy, or HIE, is a condition that occurs when a baby’s brain is deprived of oxygen during labor and delivery. When a woman is pregnant, the fetus receives oxygen and nutrients through the umbilical cord. If the blood flow between mother and fetus is cut off during the birthing process, the baby may suffer this neurological injury.

During labor and delivery, contractions result in reduced blood flow through the umbilical cord, which reduces the oxygen and nutrients delivered to the fetus. When a contraction ends, the blood supply typically returns to normal. In some cases, the reduction of oxygen and nutrients will harm the fetus, particularly for infants who have lower reserves and cannot tolerate these reductions. This is particularly true for preterm infants and growth-restricted babies.

There are a number of potential causes of HIE. This includes:

• Umbilical cord injuries, including nuchal cord (the umbilical cord wrapping around the baby’s neck), cord prolapse (where the umbilical cord is compressed from preceding the baby’s exit from the uterus, and umbilical cord compression due to excessive uterine activity (often caused by hyperstimulation when labor is induced;
• Problems with the placenta or uterus, including a ruptured uterus, placental insufficiency, or placenta previa (where the placenta is attached to the uterine wall close to or covering the cervix);
• Tachysystole, or excessively frequent uterine contractions;
• Elevated fetal heart resting tone between contractions;
• Trauma to the baby’s brain during delivery; and/or
• Delayed delivery of the baby

HIE can also occur during fetal development. This may occur due to an infection (such as toxoplasmosis), abnormal development of the heart and/or lungs, maternal hypertension or hypotension, or low maternal oxygen levels. It may also happen in older children and adults due to any issue that may interrupt blood flow to the brain, such as asphyxiation, overdose, or poisoning.

Hypoxic-ischemic encephalopathy is considered a medical emergency. Immediately after birth, medical professionals will perform tests, such as an Apgar assessment. The Apgar score checks for:

• Appearance – skin tone and color
• Pulse – heart rate
• Grimace – reaction to stimulation
• Activity – a measure of muscle tone or movement
• Respiration – breathing effort, or how much and how loudly a baby cries

A baby receives between 0 and 2 points for each category, with 10 possible points. A higher score is an indication that a baby is doing well after birth. A score of 7 or higher is considered a good Apgar score. Any lower score might indicate the need for immediate medical attention. This test is performed 1 minute after a baby’s birth and again at 5 minutes.

The treatment for HIE is therapeutic hypothermia or cooling therapy. This involves reducing the infant’s body temperature to 89 to 96 degrees through a cooling cap or blanket. This temperature is maintained for 72 hours before bringing the baby’s body temperature back up slowly over a period of 6 to 8 hours. This treatment must be administered within 6 hours of birth.

The goal of cooling therapy after a hypoxic-ischemic event is to slow the metabolic rate, which gives cells time to recover. This can prevent the spread and severity of brain damage. It can also reduce the risk of a reperfusion injury, which happens when blood flow is restored to the brain too quickly.

Therapeutic hypothermia is the only current treatment for neonatal hypoxic-ischemic encephalopathy. It has a high rate of success in limiting the damage caused by HIE. However, it is important to understand that it cannot reverse brain damage that has already occurred. 

HIE causes brain damage due to oxygen deprivation (also referred to as anoxia or hypoxia).  When the brain is deprived of oxygen, the brain cells may die – which can result in physical and/or mental disabilities. HIE can cause a number of long-term consequences, including conditions like cerebral palsy, epilepsy, and intellectual disability. HIE is also linked to developmental issues, behavioral challenges, blindness, hearing loss, and sensory issues.

In some cases, children with milder cases of HIE who receive immediate treatment may have few long-term effects. In other situations, a child with more significant brain damage may be disabled and require lifelong treatment and therapies. In the most severe cases of HIE, the condition can be fatal.