Causes and outcomes of Hypoxic Ischemic Encephalopathy (HIE)

Newborn baby girl inside incubator in the NICU

At Gluckstein Personal Injury lawyers, we are privileged to be consulted by parents of children with neurological disabilities. Many of these children have been diagnosed with Cerebral Palsy, also called CP.

Cerebral Palsy

Cerebral palsy is the most common motor function disability of childhood. Caused by abnormal development or damage to a developing brain, it is estimated that about one in 350 to one in 500 children will be diagnosed with this disorder.

While some cases of cerebral palsy are unavoidable, it is possible that a medical provider’s negligent actions or perhaps inaction either cause or contribute to a child’s brain injury, resulting in the development of CP.

There are many causes of cerebral palsy, including those related to issues occurring during labor and delivery, and birth trauma.

You can find more detailed information about CP and the possible causes here.

Contributing Factors of Cerebral Palsy

A major factor that can cause cerebral palsy is lack of oxygen to the brain during delivery. This is clinically known as ‘intrapartum asphyxia’. Intrapartum is the time spanning childbirth, from the onset of labor though the delivery of the baby.

About 1 in 5 cases of CP occur due to difficult deliveries. Lack of oxygen to the baby’s brain during labor is believed to be the cause of most of these cases.

Asphyxia may result in varying degrees of Hypoxic Ischemic Encephalopathy (HIE), depending on the duration of the lack of oxygen to the baby’s brain. HIE is a brain injury arising from inadequate blood flow to the infant’s brain during the prenatal, intrapartum or neonatal period.

The cause of HIE is not always easy to identify and it is a challenge for medical malpractice lawyers. They must not only identify it but also prove it. This is done by expert opinion evidence. This always requires the expertise of specialists in neonatology and pediatric neuroradiology. It also requires specialized and skillful lawyers who understand the pathophysiology of development of HIE and cerebral palsy.

It is important to identify the cause of the brain injury. Defence lawyers will advance a theory that it is due to a genetic abnormality, or another cause that was unavoidable or untreatable.

Factors that can lead to HIE include cord prolapse, uterine rupture, placental abruption, placenta previa, maternal hypotension or hemorrhage, breech presentation, or shoulder dystonia.

Most cases of HIE have evidence of infant distress, either in labour or after delivery. These indicators include:

  • abnormal fetal heart rate tracings
  • poor umbilical cord gases
  • low Apgar scores
  • presence of meconium-stained fluid during delivery
  • the need for resuscitation following delivery

How medical professionals can prevent brain injury

The duration of the period of fetal asphyxia can be reduced with the use of Electronic Fetal Monitoring (EFM), and prompt intervention.

EFM monitoring is an obstetrical tool that monitors the fetal heart rate during labour. It can assist in determining fetal distress or abnormal blood flow to the infant during labour. The fetal heart may be fast or slow, or there may be poor variability or slow recovery from normal decreases in the fetal heart rate. There are many signs that the care providers should be familiar with.

Continuous Electronic Fetal Monitoring is a tool frequently used by obstetrical care providers to ensure fetal well-being during labour.

Two leads from the electronic fetal heart rate monitor are attached to the mother’s abdomen. They detect maternal contractions and the fetal heart rate and provide a strip that the health care team can interpret. Sometimes this is not done in accordance with standards and guidelines. This can result in fetal distress being unrecognized and untreated.

Fetal distress can occur for many reasons including reaction to medications or issues with the umbilical cord or placenta.

Simply put, a mother breathes oxygen into her lungs. Oxygen is carried by her blood to the placenta, from where it is transferred to the fetus through the umbilical cord. Anything that interrupts this process for a prolonged period of time may result in fetal distress. Compression of the umbilical cord during a contraction is often the culprit.

A simple analogy is a kink in a garden hose when you are watering plants in your garden. If you do not fix the kink, the water cannot flow and the plants will not get the water they need, so they wither and die. The same thing occurs with brain cells when they are deprived of oxygenated blood.

The passage we all take through the birth canal has been called the most dangerous journey that we will take in our lifetime.

Who is responsible?

Mothers and their unborn infants are reliant on their obstetrical care providers, including obstetricians, midwives and nurses. They are responsible for ensuring that this journey is navigated safely. They must respond to any emergencies that occur along the way in an expeditious and careful manner.

Fetal distress should be responded to promptly by a wide range of interventions from repositioning and oxygenating the mother or stopping oxytocin (the drug that induces labour) to operative delivery with the use of forceps or by Cesarian Section depending on the stage of the labour, the position of the baby and the severity of the fetal distress.

The consequences of failing to recognize and intervene in the face of evidence of asphyxia is HIE.


The diagnosis of HIE is confirmed by MRI, which can be obtained as early as 12 -24 hours after birth. They show injury patterns as early as 1 day after birth. Particularly useful in determining the timing and extent of the injury is where there is an MRI at Day 1 and a follow up MRI after Day 4.

When there is no diagnostic imaging consideration should be given to obtaining an MRI, as the imaging is key evidence in these cases, along with the fetal heart strips and laboratory results.


Treatment of HIE involves cooling the baby, immediately after HIE is suspected. The baby will be placed on a cooling blanket which is a few degrees below normal body temperature for three days. Research has shown that cooling may lessen the extent of injury to the brain. Delay in commencing this treatment may be a sign of negligence on the part of the health care team.

How can we help you?

At Gluckstein Personal Injury Lawyers we have a team that is dedicated to obstetrical errors, birth injury, medical negligence and neonatal cases. They have the experience and expertise to determine whether your child’s neurological injury is related to you and your baby’s medical providers actions or inactions. These include cases in which HIE is a primary cause and others such as Kernicterus, and Hypoglycemia, where HIE may be a non-factor.

We retain leading experts in the obstetrical, neonatal and neuroradiology fields to determine whether there were breaches in the standard of care you and your baby received and establish if those breaches caused your child’s disabilities.


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