As you approach your due date, you’re likely focused on preparing as much as possible to ensure a safe and healthy delivery. That’s why it’s so important to plan ahead for the small chance that something goes wrong. One possible complication is hypoxic-ischemic encephalopathy, a birth injury that occurs in 1.5 out of every 1,000 live births. Here’s what you need to know about this dangerous brain dysfunction, should it occur during your delivery.

What Is Hypoxic-Ischemic Encephalopathy?

Hypoxic-Ischemic Encephalopathy (HIE) is a type of neonatal brain injury that occurs around the time of birth, caused by oxygen deprivation and/or limited blood flow to a baby’s brain.
This deprivation sets off a chain reaction in the newborn’s body whereby cells become injured, then die and release certain substances that are toxic to other cells. HIE can result in permanent brain damage or disability—such as cerebral palsy—and, in some cases, even infant death.

However, a treatment called therapeutic hypothermia is regularly being used by hospitals to minimize the risks associated with HIE for newborns. Hypothermia therapy can slow down the injury process, allowing an infant’s brain the chance to heal and minimizes the spread of damage. Clinical evidence has shown that therapeutic hypothermia has helped full-term newborns with moderate to severe HIE.

How Does Hypothermia Treatment Work?

Hypothermia treatment—also known as cooling therapy, brain cooling, and neonatal cooling—is a procedure that can minimize permanent brain damage associated with HIE. It works by lowering a newborn’s body temperature below homeostasis (with a common target temperature of 92.3 degrees Fahrenheit) to allow the brain to recover from a hypoxic-ischemic injury.

Hypothermia treatment can be administered by using a cooling cap. This is known as “selective brain cooling.” It can also be done by placing the newborn on a waterproof blanket that contains cool, circulating water to cool the baby’s entire body. This is known as “whole-body cooling.” While either of these options seem to be effective, the most critical aspect of the procedure is time. Cooling therapy must be administered as soon as possible after birth or the oxygen-depriving incident—ideally within six hours.

Once a newborn’s temperature has been lowered, it should remain there for up to 72 hours. The cooling allows cells to recover, which can help prevent the spread and severity of brain damage. Meanwhile, medical professionals will carefully monitor the baby’s health—both during and after the treatment—and provide any additional interventions that may be necessary. This vigilant monitoring includes:

• Keeping glucose and electrolyte levels consistent
• Administering blood gas tests and managing acidosis (excessive acid in the blood)
• Managing respiratory and cardiovascular support as needed
• Maintaining sedation at an appropriate level
• Monitoring for signs of seizure activity and controlling seizures

What You Need to Know About Cooling Therapy

The criteria for therapeutic hypothermia continues to evolve as research progresses, which means it may vary slightly from hospital to hospital and will be determined at the time of the sentinel event. The only absolute, universal criteria used to determine an infant’s eligibility is the infant must be at least 34-35 weeks gestational age with a sentinel event occurring at or around the time of delivery

If a newborn requires hypothermia therapy but the treatment is not provided, that may be a case of medical malpractice. What’s more, the HIE itself may even have been caused by malpractice.

How HIE-Related Medical Malpractice Is Determined

Determining when a child suffered a brain injury is not always easy, and it relies on knowing what questions should be asked at the first sign of concern about your child’s development or upon receiving a diagnosis of cerebral palsy. Don’t be alarmed if you don’t have the answers to the following questions. Experienced legal and medical professionals can often get the answers you need, whether through interviewing witnesses or reviewing your child’s medical records,

• Did your child experience asphyxiation during labor and delivery?
• Did your child require resuscitation?
• Did you require oxygen during labor and delivery?
• Were you asked to change positions (side to side) during labor and delivery?
• Did you require medication to help keep the baby’s heart rate in the appropriate range during labor and delivery?
• Did delivery of your child require a vacuum or forceps to assist delivery of the baby?
• What were the recorded blood gases after delivery?
• Did your child experience a seizure?
• Did your child’s MRI show a brain injury?
• Did your child suffer low blood pressure, kidney or liver dysfunction?
• If not used, would hypothermia therapy have been the best course of treatment for your child? Why was it not considered?
• If hypothermia therapy was used, was it performed correctly and with informed consent?

Contacting a birth injury lawyer as soon as you are concerned is an important step in getting the answers you need and determining if you have grounds for a medical malpractice lawsuit within the statute of limitations.

After your case evaluation, if you do have a case, your lawyer will prepare the case, file the suit, and begin the discovery process. During this time, attorneys will investigate your case even further by reviewing documents and interviewing witnesses in formal proceedings known as depositions. The doctor or hospital may try to negotiate at this point, and your lawyer will help you understand whether the offer they are making is fair or if further settlement negotiations or a trial will be needed to determine what kind of compensation your family is eligible for and how much. This is a complex process, so the sooner you file, the sooner any recovered compensation can begin helping your child with the care they need.

If you suspect that your child’s birth injury was the result of medical error, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs. They support families just like yours through the stressful process associated with medical malpractice.

Reviewed by:
Trish Fletcher, MS, BSN, CRNP, NNP-BC, ALNC
Neonatal Nurse Practitioner | Birth Injury Legal Nurse Consultant

Tricia is a dedicated, focused, Birth Injury Legal Nurse Consultant and Neonatal Nurse Practitioner with more than 25 years of experience. Her strong clinical and critical thinking skills, paired with expertise caring for neonates in a Level III Neonatal Intensive Care Unit (NICU), ensures meticulous medical records review. READ FULL BIO

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