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Hypoxic Ischemic Encephalopathy (HIE) in Newborns and Neonates

Hypoxic ischemic encephalopathy (HIE) is a condition in which there is a brain injury caused by lack of oxygen and blood flow. Sometimes the brain recovers from the injury, especially if the baby is given brain cooling treatment and appropriate supportive care. Other times, there may be a permanent injury, and this can range from very mild to severe. There are numerous therapies that can help a child overcome the problems caused by brain injury. In some cases, with early and aggressive therapy, a child may overcome some or even all of the problems caused by a brain injury. In more severe cases of brain damage, therapies may be necessary, for example, to help the child’s musculoskeletal system avoid severe contracture.

In addition to therapies, sometimes children need one or more surgeries to help fix or manage problems caused by a brain injury. These therapies and surgeries can be costly.

If healthcare provider negligence caused or contributed to a baby suffering a brain injury or other type of birth injury (such as Erb’s palsy), a law firm can help the family obtain compensation for therapies, treatments, and many other things, such as home modifications for the child. Healthcare professionals usually don’t inform parents that their baby’s brain injury was the result of negligence, and sometimes, parents are made to feel that a birth injury is their fault. Birth injury law firms utilize top medical experts, including obstetricians, to review medical records to find the true cause of a baby’s birth injury.

What is HIE?

Hypoxic means lacking oxygen (insufficient oxygen in cells/tissue) and ischemic means reduced blood flow. Many babies start to experience seizures when they suffer from HIE. Conditions such as cerebral palsy, developmental delays, cognitive disorders, motor disorders (low muscle tone, high muscle tone, tight (spastic) muscles, etc.), and seizure disorders are often caused by HIE.

When a baby is diagnosed with HIE in the newborn/neonatal period, it is often caused by oxygen deprivation that occurred during labor and delivery. There are numerous conditions that can cause a baby to be deprived of oxygen, such as umbilical cord problems, placenta problems, a ruptured uterus, excessive Pitocin, and abnormal amniotic fluid (which increases the risk of umbilical cord problems). However, during labor and delivery, the baby’s heart rate is supposed to be closely monitored. If a condition such as the cord being wrapped around the baby’s neck (nuchal cord) causes the baby to experience oxygen deprivation, this will be reflected in the fetal heart rate monitor tracings. When these abnormal tracings occur, conservative measures may be utilized to try and relieve the fetal distress (such as repositioning the mother). If the distress cannot be relieved and fetal heart tracings remain abnormal, the healthcare team must prepare for an urgent/emergent delivery, which is typically done via emergency C-section. If conservative measures do relieve the fetal distress, the delivery team should still prepare for a possible emergency C-section and continue to closely monitor the fetal heart rate tracings.

If a baby is not promptly delivered when she is experiencing oxygen deprivation, her brain may become injured. She may be limp, pale, not crying, and/or blue at birth, and she may need stimulation in order to start breathing. She may need a breathing tube and may require a breathing machine, called a ventilator, to breathe. These babies may have low scores of health at delivery, called Apgar scores. And many babies who were deprived of oxygen during the labor and delivery period require a stay in the neonatal ICU (NICU) and are diagnosed with HIE and seizures.

What does a diagnosis of HIE mean?

When a baby is diagnosed with HIE, it means the baby has a brain injury caused by lack of oxygen and reduced blood flow in the brain. The baby’s brain swells and there are ongoing processes within the brain related to the brain’s injury and its response to injury. Brain injury is an evolving process, and the medical team will monitor this closely with brain imaging studies and other tests.

What is the treatment for HIE?

There is a treatment that can help halt the injurious processes that start to occur when a baby has suffered oxygen depriving insult to the brain and has HIE. This treatment is called hypothermia (brain cooling) treatment, and for best results, it should be given as soon as possible following labor and delivery. The baby must meet certain criteria to qualify for brain cooling. When a baby qualifies, the baby’s core body temperature is slowly lowered, and the baby receives the cooling treatment for 72 hours.

Brain cooling is the only real treatment for HIE. Other treatments are supportive, meaning they are used to make sure blood flow and oxygenation and ventilation are good. Sometimes organs other than the brain may be affected by oxygen deprivation, so the medical team will make sure to maximize the care of these organs. Babies with HIE may be placed on a ventilator or they may be given oxygen through nasal prongs. Sometimes, they just receive supplemental oxygen through a mask or nasal pillows in a therapy called CPAP (continuous positive airway pressure).

Babies with HIE will typically be monitored for seizures and periods of apnea (although there will be no apnea if a baby is on a ventilator with a set rate). Seizures are a sign of brain injury, but they can also cause further brain injury, so it is important to promptly diagnose and treat these. Apnea must also be prevented as a lot of apneic periods can further damage a baby’s brain.

Sometimes babies with HIE fully recover and have no problems. Other times, they are diagnosed with cerebral palsy, low muscle tone or other issues. The healthcare team may want to start physical therapy right away to help the baby’s muscles. When a baby has a condition such as cerebral palsy, early, aggressive physical and occupational therapy can be very beneficial. Speech therapy may be needed as well so that the baby’s orofacial muscles can be assessed and trained – and so that any swallowing disorders are recognized.

In short, oxygen deprivation during labor and delivery can cause a baby to suffer HIE. The brain may recover from HIE, especially if a baby was timely given brain cooling treatment. Sometimes, however, HIE results in permanent damage to the brain. Brain damage can range from very mild to very severe. Different types of therapies can be extremely helpful in minimizing the problems caused by brain damage, and these therapies should be initiated as early as possible.


In some cases, a baby may have suffered HIE, with the medical team either failing to recognize this or failing to fully inform the parents. Later, brain injury caused by HIE may manifest as developmental delays, such as a speech delay and/or other delays in meeting developmental milestones.

If your baby is experiencing developmental delays or other issues, it may be a good idea to have an attorney who specializes in birth injury cases review your records to determine if there was negligence that caused a brain injury and resultant problems. There is no cost to you to have an attorney look at all the medical records related to your baby’s birth and post-delivery care. The birth injury attorneys at Grewal Law understand that parents are busy, and they do all the work required to obtain and review the medical records. Obtaining compensation for a child that has a birth injury is very important because therapies and treatments can be costly, especially if a child will need treatment for a lifetime. There are many different types of therapies and treatments, and parents typically want their child to receive all treatments and therapies that have a chance of providing benefit to their child.

If you think your baby experienced a traumatic birth, oxygen deprivation, a brain bleed (often caused by the use of forceps or a vacuum extractor), delayed delivery, or delayed emergency C-section – or if your baby’s care was mismanaged after birth in the NICU, please contact our team of award-winning Michigan birth injury attorneys. The medical malpractice team at Grewal Law is comprised of attorneys and healthcare professionals, including a physician, registered nurse, pharmacist, paramedic, occupational therapist, and respiratory therapist.

Scott Weidenfeller, an award-winning medical malpractice attorney, has recovered millions of dollars for families of injured babies and children, and this includes 2 recent settlements that were over $7 million each. The Grewal team is comprised of outstanding negotiators, and the firm was instrumental in negotiating the half a billion-dollar settlement from MSU for survivors of Larry Nassar’s abuse. Indeed, the team at Grewal Law represented – and still represents – one-third of the Nassar Survivors.

If your baby was diagnosed with HIE, seizures, cerebral palsy, motor disorders, low muscle tone, a speech delay, periventricular leukomalacia (PVL), hydrocephalus, intellectual disabilities, or developmental delays, or if you experienced problems during delivery or shortly before or after birth, please call us. Our medical malpractice attorneys and medical staff are available to speak with you. We are here to answer your questions 24/7.

*Although there may be some costs in investigating and pursuing claims, we will not charge a professional fee unless there is a settlement or jury verdict in your favor.

*This blog does not contain medical advice. Please speak to appropriately licensed healthcare providers if you are seeking medical advice.

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