Birth Asphyxia Lawyers Helping Children with Hypoxic Ischemic Encephalopathy (HIE) & other Birth Injuries

In the absence of major congenital problems, most neonatal seizure and brain dysfunction disorders – including hypoxic ischemic encephalopathy (HIE) – are caused by events that occur during the period right before, right after or during birth. Injuries that occur during labor and delivery are called birth injuries. Most birth injuries are caused by a lack of oxygen to the baby’s brain during labor and delivery, which is called birth asphyxia. Brain injury caused by oxygen deprivation is called hypoxic ischemic encephalopathy. HIE often causes a baby to have seizures, periventricular leukomalacia (usually in premature babies), cerebral palsy (CP), developmental delays and intellectual disabilities.

Birth asphyxia affects numerous body systems. It can cause HIE, seizures, intracranial hemorrhages (brain bleeds), hypoglycemia, respiratory distress syndrome (RDS) and many other problems in a newborn. In this article, we discuss events that may occur during or near the time of birth that can cause a baby to be deprived of oxygen. We examine birth asphyxia, HIE, and related problems that affect the baby so that parents know what to expect after their child experiences birth asphyxia.

Exclusive Legal Help for Hypoxic Ischemic Encephalopathy and Birth Injuries Since 1997

If your baby suffers from HIE, cerebral palsy, seizures or any other lifelong condition, contact the award winning birth injury lawyers at ABC Law Centers: Birth Injury Lawyers. Our firm is unique in that we focus solely on birth injury law and have been practicing in this area for almost 3 decades.  ABC Law Centers: Birth Injury Lawyers is recognized in Best Law Firms by U.S. News and World Report, and partners Jesse Reiter and Rebecca Walsh are recognized in U.S. News and World Report Best Lawyers.

Birth asphyxia is a condition caused by oxygen deprivation so severe that it causes harm to the baby, usually in the form of brain injury and hypoxic ischemic encephalopathy (HIE). There are many events that can occur during or near the time of delivery that can cause a baby to experience a lack of oxygen to her brain. However, if the medical team closely monitors the mother and baby during labor and delivery and properly interprets the baby’s heart tracings on the fetal heart monitor, the baby can be quickly delivered before oxygen deprivation causes permanent injury. Usually, a C-section delivery is the fastest and safest way to deliver a baby who is in distress. When a baby is experiencing oxygen deprivation, called fetal distress, it will manifest on the fetal heart monitor as a non-reassuring tracing.

Listed below are events that can cause a baby to experience birth asphyxia.

• Placental abruption: This is where the sac that holds the baby – the placenta – separates from the wall of the uterus. This can result in severe bleeding and loss of oxygen to the baby.
• Umbilical cord problems: Cord problems causing birth asphyxia include nuchal cords (cord wrapped around baby’s neck), umbilical cord prolapse, short umbilical cord and cord in a true knot. These conditions can cause a baby to be partially or completely deprived of oxygen.
• Delayed emergency C-section: Often, complications warrant a quick delivery of the baby. A delay can mean the baby is deprived of oxygen for too long.
• Improper fetal monitoring: It is the standard of care to continuously monitor the baby’s heart rate as soon as the mother is admitted to the labor and delivery unit.  Failure to quickly recognize and act on non-reassuring heart tracings can cause the baby to experience severe oxygen deprivation.
• Placenta previa: This is when the placenta grows close to the opening of the uterus, which can partially or completely block the mother’s cervix, which is the opening to the birth canal.
• Ruptured uterus (womb): This occurs when there is a tear through all the layers of the womb. A ruptured uterus can cause severe hemorrhaging in the mother, and the baby may even spill into the mother’s abdomen. The hemorrhaging can cause the mother to lose so much blood that there is a decreased flow of blood to the baby, or the rupture may be at a spot that affects the blood circulation between the uterus and placenta.
• Preeclampsia / eclampsia: This is when the mother has high blood pressure diagnosed during pregnancy, which can cause a decreased flow of blood to the baby.
• Premature rupture of the membranes (PROM) and premature birth: PROM occurs when the water breaks before the mother goes into labor. PROM can cause umbilical cord compression, premature birth and being born before the lungs are fully developed, which can cause a lack of oxygen to the baby’s brain.
• Oligohydramnios: This is a condition in which the mother has low amniotic fluid.  Oligohydramnios puts the baby at a significant risk of having a prolapsed or compressed umbilical cord. Oligohydramnios can also lead to meconium aspiration, which can cause respiratory distress and oxygenation problems.
• Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis.
• Prolonged and arrested labor.  Contractions during labor are traumatic for the baby, and when labor is prolonged, there can be a lack of oxygen to the baby’s brain that gets progressively worse, especially if Pitocin or Cytotec are used.
• Fetal stroke: This is when blood vessels in the baby’s brain become blocked or restricted. Forceps and vacuum extractors can cause the baby to have a stroke, which can cause severe oxygen deprivation. Hypoxic ischemic encephalopathy (HIE) and stroke often occur together.
• Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery.  Forceps and vacuum extractors can cause brain bleeds and HIE. Mismanagement of cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia also put a child at risk of experiencing a brain bleed and HIE.
• Hyperstimulation caused by Pitocin and Cytotec can also cause oxygen deprivation that gets progressively worse.
• Improper management of the baby’s respiratory status after birth: This includes failure to properly manage apnea (periods of breathing cessation), failure to properly manage a baby on a breathing machine (which can cause overventilation injuries, such as hypocarbia and a hole or holes in the lungs), and failure to give proper amounts of surfactant, which helps with lung maturity and lung compliance in premature lungs.

Hypoxic ischemic encephalopathy is a brain injury caused by a lack of oxygen to the baby’s brain. The lack of oxygen can be caused by decreased oxygen in the baby’s blood (hypoxemia / hypoxia) and / or a decreased or restricted blood flow in the baby’s brain. HIE should be suspected if the baby had to be resuscitated right after birth, had a low Apgar score, experienced seizures soon after birth, had an acidic umbilical cord blood gas sample, is limp, is having breathing problems, and/or is having feeding difficulties.

It is crucial for physicians to promptly diagnose HIE in a baby because treatment must be given within six hours of the insult that caused the asphyxia and HIE, which usually means the treatment must be given soon after birth. Hypothermia (brain cooling) treatment for HIE has been shown to slow down almost every injurious process that begins to occur when the brain experiences an oxygen-depriving insult. It helps prevent the child from developing cerebral palsy and it can decrease the severity of the CP.

Hypoxic ischemic encephalopathy (HIE) is the most common cause of newborn seizures.  Seizures occur when the brain is injured and abnormal, continuous electrical discharges take place. A baby experiencing a seizure may have involuntary jerking movements that can last several seconds or a few minutes. Often, however, there are no outward signs that a baby is having a seizure. Thus, babies suspected of having HIE must be frequently tested by electroencephalography (EEG) in order to ascertain if seizures are occurring. Many neonatal intensive care units now have the equipment to perform continuous EEG monitoring on newborns.

Seizures can cause permanent brain injury, so they must be promptly recognized and treated.  After initial management of airway and cardiovascular support and identification and treatment of the underlying cause of the seizures, the physician will typically initiate antiepileptic drug (AED) therapy if the seizures continue. Common AEDs include phenobarbital, diazepam, lorazepam, and phenytoin.

Intracranial hemorrhages are bleeds within the skull or brain.  Bleeds can be caused by birth asphyxia and trauma that occurs during delivery.  Forceps and vacuum extractors are a common cause of brain bleeds in newborns.  Mismanagement of abnormal positions, such as breech and face presentation, and attempted vaginal delivery when shoulder dystocia or cephalopelvic disproportion are present can also cause intracranial hemorrhages.  Babies who are premature are susceptible to intraventricular hemorrhages (IVH), which is bleeding into the brain’s ventricular system.  This is the most serious type of intracranial hemorrhage and it is more common in premature babies because their blood vessels are not fully developed and are therefore weak.  The best way to prevent IVH in a baby is to prevent premature birth.

Hypoxic ischemic encephalopathy (HIE) is another cause of intracranial hemorrhages.  HIE causes cell degradation and death, which causes blood vessel walls to break down, leading to bleeding.

Brain bleeds place a baby at a high risk of suffering from seizures. Treatment for brain bleeds includes making sure the baby’s blood pressure is normal and that the baby is getting help breathing if she needs it. Frequent measurements of hematocrit (red blood cells) should be done, and in most cases, measurement of head size should be performed. Head imaging and coagulation (blood clotting) studies are also essential.

Treatment for blood loss includes giving the baby blood and other therapies to increase blood volume and blood pressure. This includes packed red blood cells, fresh frozen plasma, and normal saline administration.

In cases of a subdural hematoma, surgery to remove excess fluid and blood may need to be performed to decrease pressure inside the brain, and emergency surgery is needed when there is brainstem compression caused by bleeds in parts of the brain that don’t have as much plasticity (ability to move) as other parts.

Neonatal hypoglycemia (NH) is a condition in which an infant’s glucose (also known as blood sugar) falls to unsafe levels in the first few days after birth.  Babies need glucose for energy, and most of the glucose is used by the brain.

Hypoglycemia is one of the most common metabolic problems in babies, and severe NH is one of the leading causes of brain injury. Neonatal hypoglycemia is not difficult to discover in a newborn, and usually it is very easily treated. Untreated NH, however, can have serious consequences for the infant because glucose is the major component for energy in all organs, and in the brain, glucose is used almost exclusively for energy / metabolism. The baby’s brain tissue depends on a steady supply of glucose as its main source of fuel. Therefore, if the amount of glucose supplied by the blood falls, the brain is one of the first organs affected. When brain cells receive insufficient glucose, they start to die.  This can cause cerebral palsy and seizures.

Hypoglycemia is a common effect of birth asphyxia.  All babies should have their glucose levels monitored, but if a baby experienced asphyxia during birth, the medical team should be on alert that the baby may NH.

Respiratory distress syndrome (RDS) is another condition associated with birth asphyxia.  Most commonly, RDS is caused by a deficiency of surfactant in the baby’s lungs due to premature birth. Surfactant is a lipoprotein the lungs produce to help the lungs be more compliant and able to easily expand and retract. Surfactant helps prevent the airways (alveoli) from collapsing at the end of exhalation, and it also helps recruit the airways that have collapsed. When the baby has insufficient surfactant, her lungs will be stiff and there can be a lot of collapsed airways. This can make it very difficult for the baby to breathe, even if she is on a ventilator. Stiff lungs on a ventilator can become seriously injured. In addition, babies with stiff lungs and respiratory distress are prone to getting lung infections and pneumonia. Stiff lungs, collapsed airways and infection can cause the baby to suffer from a lack of oxygen to her brain, which can cause hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL) and cerebral palsy. Thus, surfactant is very important for the baby. If the baby is born before 35 weeks – and especially if she is born before 30 weeks – she will likely require surfactant replacement therapy. Three doses of surfactant are usually given within a 72 hour period.

When a baby is born prematurely – or about to be born prematurely – physicians must make every effort to prevent the serious problems associated with preterm birth, such as RDS, sepsis, brain bleeds and PVL. When a baby is less than 34 weeks of gestation and the physician suspects she will be born soon, corticosteroids should be given to the mother to help the baby. Betamethasone is the most commonly used steroid, and it has been shown to reduce the incidence and severity of respiratory distress syndrome (RDS), intraventricular hemorrhages, sepsis (which can cause meningitis) and PVL. When appropriately given to the mother, corticosteroids help the baby’s lungs mature before the baby is delivered. The drugs also help numerous tissues throughout the baby’s body mature.

When a baby has respiratory distress syndrome, a ventilator may be used to help her breathe. If the ventilator settings are not properly managed, the baby may receive breaths that are too large and fast, which can cause overventilation injuries such as hypocarbia and a pneumothorax (a hole or holes in the lungs). Overventilation injuries can cause the baby to have PVL, cerebral palsy and hypoxic ischemic encephalopathy (HIE).