Hypoxic Ischemic Encephalopathy (HIE) is a type of birth injury that happens when a newborn’s brain doesn’t receive enough oxygen due to decreased blood flow. The consequences of HIE depends on the severity of the diagnosis. Mild HIE cases can result in little or no long term impact. A diagnosis of moderate HIE can mean intellectual, cognitive delays or some physical deficits and possible long term diagnosis of cerebral palsy. Severe HIE, when it is not fatal, usually results in permanent and severe cognitive and physical deficits, and a significant chance of developing CP.
There’s no denying the inherent danger associated with HIE. The Florida Neonatal Neurologic Network has established statistics stating that 20 out of every 1,000 births are affected by HIE. In Canada, the Canadian Pediatric Society suggests the incidence of HIE is up to 6 of every 1000 births. Whatever the incidence of HIE is, the fact remains that the diagnosis can be devastating and carries with it a future that may require long term treatment, care and rehabilitation.
At BILA, we are committed to assisting parents of children with HIE with more than just legal support. In this article we are going to discuss the importance of identifying HIE as early as possible, the developmental milestones parents should keep in mind throughout the infant’s first year, common tests and treatments, as well as general parental advice.
We’re here for you and your baby. You always feel free to reach out to us with any questions or concerns you may have. There is no charge for any consultation with a BILA lawyer.
The Importance of Early HIE Detection
HIE is an injury that most commonly happens when there is oxygen deprivation to the brain during the perinatal period, which is the time just before and after delivery. HIE that is caused by asphyxia is known to be the leading cause in infant fatality, which is why medical professionals should always fully evaluate newborns for HIE if there were any kind of delivery complications, signs of fetal distress, or early signs of brain injury exhibited by the baby.
One of the main reasons why it’s so crucial to detect HIE as quickly as possible is because HIE can be treated with therapeutic hypothermia (cooling therapy) that is clinically proven to reduce the risk of serious or permanent injury in moderate to severe HIE. However, in order to be effective, HIE therapy must start within six hours after a child’s birth for the best results.
So this means that your child’s best chance of recovering from HIE is if they are diagnosed within a few short hours after birth.
Detecting Developmental Delays associated with HIE
As much as it’s important to detect signs of HIE as soon as possible, the reality is that many HIE cases aren’t detected until months or even years after an infant’s birth. Many times parents will begin to notice signs of HIE when their baby misses certain developmental milestones.
It’s important for parents to remain aware of developmental milestones as they pertain to certain age brackets. The following is a list of developmental milestones that parents should remain cognizant of within the first year of their baby’s life.
Developmental milestones for children around two months old:
- Beginning to smile at other people
- Paying attention to facial expressions
- Trying to look directly at parents
- Making gurgling sounds
- Calming methods, like sucking on hands
- Turning head towards sounds
- Following things with their eyes and recognizing people
- Holding their heads up and beginning to push up on their tummy
- Fussing or crying when acting bored
- Making smoother movements with arms and legs
Developmental milestones at six months:
- Responding to their name
- Responding to sounds by making their own sounds
- Beginning to pronounce certain lettered sounds
- Making happy and joyful sounds
- Enjoying playing with others
- Knowing familiar faces and knowing when someone is a stranger
- Beginning to string vowels together (“Oh’s” and “Ah’s”)
- Bringing things to their mouth
- Beginning to sit without support
- Rocking back and forth, and maybe crawling
- Rolling over in both directions
- Supporting weight on legs
Developmental milestones at one year:
- Trying to say words they hear others say
- Saying “Mama” and “Dada”
- Using simple hand gestures
- Responding to simple spoken requests
- Making sounds associated with tone changes
- Crying when parents leave
- Putting out extremities to assist parents while dressing
- Repeating certain sounds or actions for parental attention
- Showing fear within certain situations
- Copying other’s gestures
- Banging things together
- Correctly using purposeful objects, like drinking from cups
- Easily letting things go
- Following simple directions
- Potentially being able to stand up on their own
- Getting to a proper sitting position without help
Although every child is different in terms of their development, it’s simply important to keep these milestones in mind as you go about your parenting strategies within the first year of your child’s life with HIE.
Treatments for HIE
We’ve already discussed therapeutic hypothermia, but it’s also crucial to understand the importance of early intervention for children with HIE.
Treatment regimens vary when it comes to HIE because every child’s symptoms and disabilities are unique. It’s important to understand that the following common therapies and treatments that are recommended for children with HIE are intended to help raise awareness for parents and that all treatments must always be guided by the assistance of professional medical experts.
Physical therapy: Physical therapy (PT) can help young children in terms of developing fundamental motor skills, and the overall goals of PT vary. Some goals can include improving flexibility, overall strength and even learning to walk.
Occupational therapy: This type of therapy is sometimes confused with PT, but it actually focuses on helping young children in terms of being able to complete everyday tasks and foster the first steps towards more independence from parents. This can include activities that support the advancements of cognitive abilities, visual perception and fine motor skills (for example learning to self-feed with a spoon or drink from a sippy cup)
Speech/language pathology: Many newborns with HIE exhibit delays with speaking and processing language, so this type of therapy helps address these issues.
Other common HIE treatments include the following:
- Emotional and behavioral therapy
- Massage therapy
- Sensory integration therapy
- Recreational therapy
- Stem cell therapy
No matter what diagnosis your child was given at birth or during the first year, the real answers in terms of your child’s development will only come with time. This can be one of the most difficult parts of raising a child who has been injured by HIE; the waiting.
As the months go on, you’ll cheer your child on when meeting milestones and worry when they don’t meet other milestones, and there’s simply no doubt that parents will be stressed and unsure in ways that most parents will never fully understand. It’s crucial for parents dealing with HIE to also remember to take care of themselves and watch out for signs of depression or stress with their partners.
There are going to be struggles and a certain amount of uncertainty for all parents raising a newborn with HIE, but every parent will come to find the routines that work for them throughout the child’s first year. Your schedule will begin to even out and therapies will be manageable, and ultimately you and your family will make it through these early developmental stages.
Contact us today for more information
It’s important for parents to understand that there have been countless couples who have gone through what you’re going through, and we have worked with many of these families.
We can help in terms of linking you up with our experts and past clients who can provide their knowledge, support and understanding.
So never hesitate to contact us in order to help get you and your child started out on the right track!
Susanne Raab is a lawyer at Pacific Medical Law, and an advocate for people living with disabilities. She has been selected for inclusion by her peers in Best Lawyers in Canada in the area of Medical Negligence and is recognized as a leading practitioner in the Canadian Legal Lexpert® Directory in medical malpractice. Susanne is also a Fellow of the Litigation Counsel of America, an honorary trial lawyer society whose membership is limited to less than one-half of one percent of North American lawyers, judges and scholars.