Hypoxic-Ischemic Encephalopathy (HIE)

HIE is a brain injury caused by a lack of oxygen before, during, or after a baby is born. HIE is otherwise known as birth asphyxia which can be characterized by a lack of oxygen in the baby’s blood (hypoxia) or a lack of blood flow to the baby’s brain (ischemia).

Causes of HIE

Unfortunately, there are many different possible causes of HIE. Sometimes, the cause of fetal HIE is unknown. Some of the known possible causes are:[1]

• Maternal diabetes with vascular disease
• Problems with blood circulation to the placenta
• Preeclampsia
• Chronic hypertension
• Cardiac disease
• Congenital infections of the fetus
• Drug and alcohol abuse
• Severe fetal anemia
• Lung malformations
• Excessive bleeding the placenta
• Maternal low blood pressure
• Umbilical cord issues
• Prolonged stages of labor
• Abnormal fetal presentation
• Rupture of the placenta or uterus
• Severe cardiac or pulmonary disease
• Serious infection
• Severe prematurity
• Low neonatal blood pressure
• Brain or skull trauma
• Cardiac arrest
• Respiratory failure

Preventing HIE

There are two things your doctor should do to monitor for HIE and to prevent HIE when the early warning signs are detected. First, your doctor should ensure the baby is developing properly through prenatal tests.[2] Mothers with high-risk conditions such as high blood pressure,  diabetes, or other potential complications should be monitored closely and frequently to reduce the risk of HIE.[3] Prenatal tests for HIE usually focus on fetal heart rate, blood flow, fetal movement, and amniotic fluid levels to test the oxygenation of the baby.[4] Some of these tests include Non-Stress Tests, Contraction Stress Tests, Amniotic Fluid Volume Tests, Biophysical Profiles, and Doppler Velocimetry.[5]

Second, when fetal distress is detected and the baby is at risk for HIE, doctors should attempt to deliver the baby as quickly as possible via c-section.[6] Some warning signs of HIE include:[7]

• Decreased fetal movement
• Severe maternal cramping
• Abnormal fetal heart rate
• Abnormal contraction pattern
• Vaginal bleeding
• Abnormally high or low weight gain
• Maternal high blood pressure

Once a physician detects signs of fetal distress, prolonging delivery can increase the risk of birth injury for the baby and health issues for the mother.[8] Your physician may delay performing a c-section by attempting to speed up labor to achieve a vaginal delivery by using drugs such as Pitocin or Cytotect, or by using delivery instruments like vacuum extractors.[9]  The use of delivery drugs can cause unpredictable results and sometimes can put the baby in even more fetal distress.[10] Further, if delivery instruments are used improperly, they can cause brain bleeding or trauma to the baby.[11]

You may have a claim if your doctor failed to monitor the baby properly before, during and after birth, if the doctor failed to deliver the baby fast enough, or if the doctor refused to perform a c-section and your baby suffered from HIE as a result.

If you have any questions regarding a potential medical malpractice claim for injuries related to birth, please contact Michael P. Bonner, Esq. at mbonner@bonner-law.com or call us at 305-676-8800 for a free consultation. Mr. Bonner is an attorney with thirty years of experience handling medical malpractice claims and specifically claims related to birth related injuries.

[1] https://www.birthinjuryguide.org/birth-injury-types/hypoxic-ischemic-encephalopathy-hie/

‍[2] https://hiehelpcenter.org/medical/prevention/prenatal-testing/

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‍[6] https://hiehelpcenter.org/medical/prevention/c-section-delivery/

‍[7] https://hiehelpcenter.org/medical/identifying-hie/sign-symptoms/

‍[8] https://hiehelpcenter.org/medical/prevention/c-section-delivery/

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