Birth Asphixia and HIE (Hypoxic Ischemic Encephalopathy)
Hypoxic Ischemic Encephalopathy (HIE) is a serious birth injury that affects the brain of a newborn baby. It is a broad term used to refer to any harm that a baby experiences at or near the time of birth. Other terms used for HIE include “birth asphyxia,” “perinatal asphyxia” and “neonatal encephalopathy.” While there is not one exact cause of HIE, the injury presents due to oxygen deprivation by way of reduced blood flow to a newborn’s brain.
The full extent of damage from HIE is often not apparent immediately after birth for two major reasons:
- Brain injury from HIE is an evolving process. When blood flow is cut off to parts of the brain, cells begin to die and release substances that are toxic to neighboring cells. A cascading effect due to increasing toxicity in the brain then causes a chain reaction, which may allow the brain injury to spread over a period of hours or days. *Therapeutic hypothermia can help disrupt this chain reaction.
- Damage from HIE may occasionally not become apparent until a child has developmental delays. For example, impacts on mobility may not be noticed until the child struggles to meet milestones such as crawling or walking.
Once brain damage is permanent there is no cure for HIE. However, caught early a treatment known as “therapeutic hypothermia,” where a newborn’s body temperature is reduced by a few degrees — in an effort to give the brain a chance to heal — has been shown to reduce long-term damage.
What Causes HIE?
HIE can be caused by a variety of medical complications around the time of birth. In many cases, medical malpractice also plays a role. For example, doctors may fail to properly monitor the health of the mother and baby and identify potential issues. Alternately, doctors or nurses may recognize problems, but not take them seriously enough and/or fail to intervene in time to prevent injury.
Potential Risks and Causes During Pregnancy
- Malformed Lungs
- Vascular Disease caused by maternal diabetes
- Severe fetal anemia
- Lack of proper blood circulation to the placenta
- Alcohol and/or drug abuse
- Congenital infections affecting the fetus
- Cardiac Disease
Potential Risks and Causes During Labor and Delivery
- Placental abruption
- Prolonged labor
- Dangerously low maternal blood pressure
- Uterine Rupture
- Fetal Distress
- Umbilical Cord Injuries
- Abnormal Fetal Position
Signs and Symptoms of HIE Before Birth
When an oxygen-depriving event occurs before delivery, a baby may present with noticeable signs of distress from within the womb; these signs may indicate a pregnancy requires immediate intervention like an intrauterine resuscitation or an emergency C-section. With any of the following, doctors should take prompt note and begin an assessment to decide whether a baby is at risk of HIE:
- Decreased fetal movement
- Severe maternal cramping (often accompanied by severe back pain)
- Abnormal fetal heart rate
- Abnormal contraction pattern
- Vaginal bleeding
- Abnormally low or high maternal weight gain
- Maternal high blood pressure
Note that when one or more of these signs occur, it may be possible to prevent HIE with proper intervention. Astute doctors often will instruct mothers how to recognize signs of fetal distress; doctors should monitor high-risk pregnancies closely in case an oxygen-depriving event occurs. Standard medical protocols state that when physicians see any of the above signs, they should immediately begin to assess the baby’s health and decide how to proceed safely. Failure to provide proper prenatal testing, or immediately respond to signs of distress, is negligence under the law.
Signs and Symptoms of HIE Neonatal (Immediately Following Birth)
When HIE occurs, one or more of the following indicators may be present shortly after birth:
- Low APGAR scores at one, five or 10 minutes following birth
- Difficulty feeding
- Breathing problems
- Hypotonia (low muscle tone)
- Organ problems (failure, damage)
- Acidemia (low pH in umbilical cord blood gas tests)
- Abnormal response to light
- State of abnormal consciousness (hyperalert or lethargic)
When these signs and symptoms present around the time of birth, prompt medical intervention is critical for a newborn’s health. A rapid clinical assessment of any newborn presenting with signs of HIE is necessary in order to determine if therapeutic hypothermia should be administered.
Signs and Symptoms of HIE During Infancy and Early Childhood
In some children suffering from HIE, especially those with mild-to -moderate HIE, “obvious” signs and symptoms may not present at the time of birth. However, HIE may become more pronounced later in a baby’s infancy. Signs to look for in infants include:
- Impaired motor function
- Delayed developmental milestones
- Seizure disorder
- Delayed growth
- Hearing and visual impairments
When parents notice these symptoms, it goes without saying that immediate diagnosis by their healthcare provider is essential. If doctors diagnose HIE, the baby is entitled to assistance helping maximize their abilities.
It is important to note that although signs may not emerge in the neonatal period, medical professionals should still conduct tests – such as brain imaging or electroencephalogram (EEG) – on newborns who experienced oxygen-depriving events.
These tests may reveal brain injuries that routine neonatal tests would not. If a doctor fails to properly assess a baby at risk of HIE, and therefore misses the window to provide therapeutic hypothermia, it is medical malpractice.
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