Hypoxic-Ischemic Encephalopathy (HIE) is a birth injury that occurs when decreased blood flow to the brain causes oxygen deprivation. HIE is a brain injury. The long-term effects of HIE depend on several factors, including the length of time that the baby’s brain was deprived of oxygen and the severity of the deprivation. At its most severe, hypoxic-ischemic encephalopathy can lead to death.
At BILA, we understand that parents and families often struggle with the long-term effects of HIE and related conditions. We are committed to advocating for families whose children have suffered birth injuries related to medical negligence.
Immediate Signs of Hypoxic Ischemic Encephalopathy
During labour and delivery, the blood flow to an infant may become restricted for many different reasons. This includes umbilical cord prolapse, excessive uterine contractions, high maternal blood pressure, placental abruption, uterine rupture, trauma from the use of forceps or a vacuum, or placenta previa.
When the umbilical cord is restricted in some way before, during, or after labour and delivery, the infant’s brain may experience a lack of oxygen due to decreased blood flow. Immediately after birth, the signs of HIE may include:
- Decreased alertness and activity (lethargy)
- Hyper alertness
- Lack of typical reflexes
- Difficulty feeding
- Breathing problems
- Abnormal movements or seizures
- Low muscle tone (hypotonia)
- Acidemia (low pH in umbilical cord blood gas tests)
- Abnormal response to light
Doctors should conduct an evaluation known as the Apgar test to determine whether a baby may have suffered from HIE or another birth injury. This neurological examination evaluates the baby’s colour, heart rate, reflexes, muscle tone, and respiration. A low Apgar score may indicate that the infant has suffered a birth injury related to oxygen deprivation.
In many situations, HIE is caused by medical negligence, such as the failure to properly monitor the mother or baby during pregnancy, labour and delivery, and immediately after birth. In addition, a failure to note the signs of HIE and promptly intervene with cooling therapy may be a form of medical malpractice.
Even if HIE isn’t diagnosed directly after birth, there are often signs of developmental delay, and symptoms within the first months and years after the baby’s birth. In many cases, a baby who suffered from birth asphyxia does not reach developmental milestones at the same time as their healthy peers. These developmental signs may include:
- Seizure disorder (epilepsy)
- Delayed growth
- Hearing and visual impairments
- Impaired motor function
- Delayed developmental milestones, such as responding to sounds, holding their heads up, crawling, walking, rolling over, and/or talking
Even if a baby does not show signs of HIE or another birth injury immediately, parents should be aware of these developmental signs and symptoms. Tests such as magnetic resonance imaging (MRI) of the brain or an electroencephalogram (EEG) can be used to check for signs of brain damage due to oxygen deprivation. Although therapeutic hypothermia (cooling therapy) can only be used within a few hours of a suspected case of birth asphyxia, there are numerous potential interventions and therapies that can be utilized when a child has a developmental delay. For families, dealing with HIE can be challenging – but there is hope with proper diagnosis and treatment.
Long-Term Outcomes of Babies Born with HIE
Each case of neonatal encephalopathy is different. The long-term effects of HIE will vary significantly based on the following:
- The duration of the perinatal asphyxia;
- The severity of the oxygen deprivation;
- Whether therapeutic hypothermia/whole body cooling therapy was administered shortly after birth;
- The baby’s condition immediately prior to birth; and
- The medical treatment and other interventions that a child receives in the first years of their life.
Doctors typically use a tool called Sarnat staging to classify the severity of neonatal encephalopathy (brain injury). This analysis examines six categories to determine the severity of the infant’s HIE as either Stage I (mild encephalopathy), Stage II (moderate encephalopathy), or Stage III (severe encephalopathy). These categories include (1) level of consciousness; (2) spontaneous activity; (3) posture; (4) muscle tone; (5) primitive reflexes (such as sucking reflex); and (6) the autonomic system (heart rate and respiration).
A child who has suffered from neonatal encephalopathy may be diagnosed with one or more related conditions, including:
- Cerebral palsy
- Epilepsy or seizure disorders
- Behavioural and emotional disorders (such as executive function deficits, attention deficit hyperactivity disorder/ADHD, and autism spectrum disorder/ASD)
- Intellectual disabilities (impaired cognitive function)
- Developmental disabilities
- Skin conditions
- Learning disabilities
- Nutritional concerns
- Oral health issues
- Hearing and vision impairments
- Speech delays and language disorders
- Mental health issues (such as anxiety or depression)
- Sensory processing disorders
- Orthopaedic conditions
While many of these conditions are not curable, there are therapies and treatments that can improve a child’s quality of life. This may include physical and occupational therapy, adaptive technologies, and the use of service animals. For example, a child with cerebral palsy might benefit from electronic communication devices that help them communicate with others.
While the long-term outcomes of neonatal encephalopathy can vary considerably, the best outcomes occur when therapeutic cooling is administered as soon as possible after birth. In addition, early intervention during infancy and toddlerhood can make a significant difference in the outcome in children affected by HIE.
How BILA Can Help
If your child has been diagnosed with brain damage related to hypoxic-ischemic encephalopathy, you may not know what to do. In situations where the neonatal encephalopathy was caused by medical negligence, you may be able to file a lawsuit against the at-fault medical team.
The Birth Injury Lawyers Alliance (BILA) advocates for children and their families. We will thoroughly investigate your case and help you understand your legal rights and options. We will also work with you to find the resources that you need to help improve quality of life for both you and your child.
Does HIE Go Away Over Time?
No. HIE causes brain damage. While some babies with very mild encephalopathy suffer few long-term effects and may have few issues, babies with moderate or severe encephalopathy may develop a number of other conditions. These conditions – such as cerebral palsy and intellectual disabilities – are not curable. However, there may be treatments available to help achieve the best possible outcome in children with HIE.
If you believe that your child has suffered a birth injury, an HIE attorney can help. Call BILA today to schedule a free consultation.
What Is the Life Expectancy for People with HIE?
It depends. Very severe cases of birth asphyxia may result in death at the time of birth or shortly thereafter. Children with mild or moderate encephalopathy will typically live a long life. However, they will likely require therapies and other interventions over the course of their lifetime.
At BILA, we understand how difficult it can be for families to receive an HIE diagnosis. If your baby’s neonatal encephalopathy was caused by medical negligence, you may be able to file a lawsuit against the at-fault doctor, nurse, or other member of the medical team. Reach out today to schedule a free consultation.