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Hypoxic-ischemic encephalopathy (HIE), sometimes called “birth asphyxia” or “neonatal encephalopathy” is a serious form of brain damage that often arises from medical malpractice.
This damage occurs to babies either directly before or during birth when their blood is insufficiently oxygenated.
Phil Michels Law has successfully represented families whose children suffered HIE due to medical negligence. In one case, our firm represented a family after a hospital's failure to respond to fetal distress caused a baby to be born asphyxiated — the child developed cerebral palsy and a seizure disorder as a result. View case result →
There are several reasons why HIE develops, including high-risk pregnancy conditions and or an unexpected problem that occurs during labor or delivery. However, HIE is also often a direct result of specific actions taken by a medical professional, or failure to take appropriate action to prevent HIE from occurring.
Some of the most frequent factors associated with HIE include:
When the brains of children are denied access to necessary oxygen, cells begin dying off quickly and in vast numbers. This leads to irreversible brain damage. Should HIE occur, physicians will attempt to address the problem through an intervention called “therapeutic hypothermia,” which cools the brain and helps prevent damage. During this procedure, the baby’s body temperature is lowered to as low as 92 degrees. This lowers the body’s metabolic rate and can arrest the spread of brain damage.
Medical professionals are trained to quickly diagnose HIE and take steps to prevent or mitigate injury. If babies have low APGAR scores (a test that assesses the post-delivery health of a baby), refuse to feed, have seizures, have organ problems or breathing issues, that child may be experiencing HIE.
To make a definitive diagnosis, medical professionals will often rely on scans, MRIs, EEGs and ultrasounds.
Unfortunately, some cases of HIE are not diagnosed, and developmental disorders may not appear until the child is older. This means it is essential that medical professionals take diagnostic steps if birth trauma or other co-factors are present.
While the public may not be especially aware of HIE, prevalence of the condition is relatively high, occurring in 1.5 of 1,000 live births. It is believed that HIE is responsible for nearly one quarter of all neonatal deaths globally. Children who survive often have longstanding developmental disabilities. These issues may include cerebral palsy, epilepsy etc.
The severity of HIE aftereffects depend on the level of blood oxygen insufficiency present and how long the episode lasts.
Older children and adults can also suffer from a lack of oxygen to the brain. These incidents are often precipitated by cardiac issues, strokes or other major medical maladies.
While hypoxic-ischemic encephalopathy can have debilitating lifelong consequences, it can also be treated with therapeutic hypothermia, greatly improving the prognosis for the baby in question. This means that early detection of HIE is absolutely critical.
Treatment must be started shortly after birth (within six hours, generally) to be effective. This gives caregivers a brief window to make a diagnosis and begin working to prevent or minimize brain damage from HIE.
While all babies who were oxygen deprived in utero or during delivery need to be tested for HIE, there are some other markers that caregivers should identify as being possible symptoms of HIE. These include:
Tests for HIE detection include the APGAR score, which is used to assess the overall health of newborns. APGAR stands for Appearance, Pulse, Grimace, Activity, Respiratory effort.
Caregivers may also test for HIE by using MRIs, CAT scans and other imaging technology (to identify brain injuries related to oxygen deprivation), umbilical cord blood gas tests (which can determine if cord blood was low in oxygen) and EEGs, which can detect seizures.
Unfortunately, these telltale signs are sometimes missed for months or even years after the birth, when developmental delays become obvious. To combat these effects, prompt detection is essential -- and failure to do so in many cases amounts to malpractice.
Hypoxic-ischemic encephalopathy (HIE) is a form of brain damage that occurs when newborn babies suffer from reduced blood flow to the brain/limited oxygenation. Other common terms for HIE include perinatal asphyxia, birth asphyxia and neonatal encephalopathy.
Many HIE cases are directly caused by medical malpractice -- and the consequences of these actions are often severe and lifelong for victims. These consequences include serious, permanent brain damage or death in the worst cases.
Let’s take a closer look at some of the most common HIE scenarios.
Women who suffer from conditions such as preeclampsia and gestational diabetes need to be carefully monitored throughout pregnancy. Failure to do so can have fatal repercussions. In cases where these conditions are not given the proper level of attention and treatment, HIE may be the end result.
The umbilical cord connecting mothers and babies is an essential conduit for supplying oxygen and nutrients and removing fetal waste products. If, during the delivery, the umbilical cord is compressed or damaged, oxygen may be cut off, leading to the development of HIE.
The mother’s placenta and uterus are also critical to the process of providing babies with oxygenated blood. If the placenta separates from the uterus too early; if the placenta is not delivering sufficient blood or is too close to the cervix, or if the uterus is torn, HIE may subsequently develop.
Other Commons Ways for HIE to Develop
Neonatal HIE requires immediate medical intervention to improve the patient’s long-term prognosis. The first step is a procedure called “brain cooling” or “hypothermia treatment,” during which the baby’s brain temperature is reduced several degrees below the human body’s baseline temperature.
Babies are placed on a cooling blanket and fitted with a cooling cap, typically for three days, and are given medicines to assist with discomfort. A machine circulates water through the cap to bring the baby’s temperature to 91 degrees, slowing the metabolic rate and limiting cell damage. Following the cooling treatment, the baby is gradually returned to normal human temperatures.
During this procedure babies are closely monitored. Heart rate, breathing, temperature are all tracked and brain activity is often monitored through the use of an electroencephalogram, which checks for cerebral function. By placing small probes on the baby’s scalp, medical caregivers can monitor for possible seizures.
During cooling periods, babies typically have lower heart rates, slowed breathing and may appear sleepy. However, they may be touched and soothed in some cases and will receive necessary nutrition via IV.
In addition to brain cooling, HIE may be treated with other therapies designed to treat organs affected by the condition. This may include mechanical ventilators or ECMO machines to assist with breathing and other critical life functions.
Once neonatal treatment is complete, babies with HIE often receive medical, physical and occupational therapy to help manage symptoms related to HIE.
With timely intervention and follow up, outcomes for babies with HIE can be significantly improved.
In California, the statute of limitations for medical malpractice is generally three years from the date of injury or one year from the date you discovered — or reasonably should have discovered — that malpractice occurred, whichever comes first. For minor victims, California law provides important protections — a child has until their 8th birthday to file a medical malpractice claim regardless of when the malpractice occurred.
This is particularly significant in HIE cases, where the full extent of the brain damage may not become apparent until the child begins missing developmental milestones months or years after birth. If you have recently connected your child's diagnosis with events that occurred during labor or delivery, do not assume it is too late. Contact us for a free case evaluation — we will tell you honestly whether your claim can still be pursued.
Families who successfully pursue an HIE malpractice claim in California may recover compensation for:
Because HIE can result in lifelong disabilities including cerebral palsy, epilepsy, and cognitive impairment, the lifetime cost of care can reach into the millions of dollars. Our attorneys work with economic and life-care planning experts to ensure every aspect of your child's future needs is fully accounted for and presented to the court.
While HIE is a dangerous condition that can irretrievably change lives, there are laws that allow victims of medical malpractice to receive justice. It’s critically important, however, to work with an attorney specializing in HIE cases. Given the deep complexity of this litigation, experience is key.
HIE cases are among the most medically and legally complex birth injury cases that exist. Successfully litigating an HIE case requires attorneys who understand fetal heart monitoring, the standard of care during labor and delivery, therapeutic hypothermia protocols, and the long-term neurological impact of oxygen deprivation at birth.
At Phil Michels Law we bring a unique advantage to every HIE case — our in-house board-certified physician has served as our Medical Director since 1994 and was formerly the Clinical Director of the Emergency Department at St. John's Hospital in Santa Monica. For nearly two decades he has been specifically focused on evaluating infants and children who may have suffered birth trauma. This means from the moment you contact us, a physician is reviewing your child's case alongside our legal team — at no cost to you.
We obtain all relevant medical records including fetal heart monitor strips, prenatal care records, ultrasounds, and hospital records. We study them ourselves and then have them reviewed by experts from the best universities and hospitals in the country. If we accept your case, we advance all costs and are only repaid if we win or settle on your behalf.
If you need assistance, please don't wait to reach out to us today for a free consultation.
Hypoxic-ischemic encephalopathy (HIE) is a form of brain damage that occurs when a newborn's brain is deprived of adequate oxygen and blood flow around the time of birth. While some cases of HIE are unavoidable, many result from preventable medical errors — including failure to monitor fetal heart rate during labor, delayed response to signs of fetal distress, failure to perform a timely C-section, improper use of labor-inducing medications such as Pitocin, or failure to treat maternal infections during pregnancy. When a medical professional's negligence causes or contributes to HIE, the family has the right to pursue compensation through a medical malpractice claim.
The long-term effects of HIE depend on the severity and duration of the oxygen deprivation. Mild HIE may result in learning difficulties or attention disorders. Moderate to severe HIE can cause cerebral palsy, epilepsy, cognitive impairment, vision and hearing problems, feeding difficulties, and developmental delays. In the most severe cases, HIE can result in death. Because the full extent of HIE-related damage may not become apparent until the child reaches developmental milestones, families often do not fully understand the impact of their child's injury until months or years after birth.
Determining whether HIE was preventable requires a thorough review of the fetal heart monitor strips, labor and delivery records, and nursing notes by experienced medical and legal professionals. Key indicators of preventable HIE include fetal heart rate abnormalities that went unaddressed, excessive or improper use of Pitocin, delayed delivery in the presence of fetal distress, and failure to recognize signs of umbilical cord compression. At Phil Michels Law our in-house physician reviews these records immediately at no cost to you and will give you an honest assessment of whether negligence may have occurred.
In California, the statute of limitations for medical malpractice is generally three years from the date of injury or one year from the date you discovered that malpractice occurred, whichever comes first. For minor victims, a child generally has until their 8th birthday to file a claim. Because HIE damage is often not fully understood until the child is older, many families still have legal options even years after the birth. Consult with an attorney as soon as possible to understand your specific timeline.
Families may recover compensation for current and future medical expenses, therapy costs, specialized equipment, home modifications, in-home care, the child's lost future earning capacity, pain and suffering, and emotional distress. Because HIE frequently results in lifelong disabilities, lifetime care costs can reach into the millions of dollars. Our attorneys work with economic and life-care planning experts to ensure every aspect of your child's future needs is fully documented and pursued.
HIE malpractice cases are complex and typically take between two and four years to resolve, though timelines vary depending on the facts of the case and whether it proceeds to trial. Cases that settle before trial are generally resolved more quickly. At Phil Michels Law our in-house physician allows us to begin the medical review immediately, which can accelerate the early investigation phase significantly.
Therapeutic hypothermia — also called brain cooling — is the standard of care treatment for moderate to severe HIE. It involves reducing the baby's brain temperature to slow cell death and minimize damage. From a legal standpoint, whether cooling treatment was administered, when it was started, and whether it was started within the critical six-hour window are all significant facts. Delay in initiating cooling treatment, or failure to recognize that a baby needed it, can itself constitute malpractice and may be a separate basis for damages.
Yes — and this is one of the most important things for families to understand. Many children are not diagnosed with the full extent of their HIE-related conditions until they begin missing developmental milestones, which can occur months or even years after birth. California's minor victim protections give children until their 8th birthday to file a medical malpractice claim. The clock generally runs from the date of the malpractice — which in HIE cases is typically the labor and delivery — not the date of diagnosis. If you have recently made this connection for your child, contact us immediately for a free case evaluation.