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Hypoxic Ischemic Encephalopathy (HIE)

What is HIE?

HIE (hypoxic ischemic encephalopathy) is a term used to describe brain damage that occurs near the time of birth caused by lack of oxygen and blood flow to the fetal brain.  The clinical characteristics of HIE include various combinations of fetal disturbance near or during labor and delivery (fetal heart rate abnormalities, sentinel events like uterine rupture or umbilical cord prolapse), umbilical cord arterial blood gas values indicative of metabolic acidosis, depressed apgar scores and a neonatal neurological syndrome.  HIE also includes the presence of brain injury consistent with clearly defined hypoxic ischemic insults.  Newborns who are diagnosed with HIE are often described as having suffered perinatal asphyxia, intrapartum asphyxia or birth asphyxia.  HIE often leads to cerebral palsy, developmental delays, cognitive impairment and other long term physical and mental disability.


The diagnosis of HIE is made based on the clinical characteristics of the newborn immediately after birth and brain imaging studies demonstrating a brain injury pattern caused by lack of oxygen (hypoxia) and lack of blood flow (ischemia).  Newborns who suffer HIE during labor and delivery are born severely depressed.  They have low apgar scores, they are limp, pale and often require resuscitation, including chest compressions and assistance with breathing.  Fetal heart rate abnormalities consistent with fetal hypoxia and metabolic acidosis are always present on the electronic fetal monitor when the fetus is exposed to damaging degrees of hypoxia and ischemia.

Every second counts

The length of time the baby was deprived of oxygen matters because it sets the stage for survival with adverse effects and survival without adverse effects. Fetal death occurs 25 minutes without oxygen. In that case the delivery should be done within five minutes and no longer than 15 minutes. For the baby to survive with the best outcomes, C-sections should be done within 10-18 minutes.

The longer a fetus is exposed to severe hypoxia and ischemia during labor and delivery, the greater the likelihood that brain damage will occur.  Animal and human studies have provided extraordinary insight into the relation of hypoxic ischemic insults to abnormalities of fetal heart rate and metabolism and to the resulting brain damage.  With total asphyxia, that is, complete cessation of blood flow, brain injury can occur within 18 minutes.  Fetal death can occur in the setting of total asphyxia for greater than 25 minutes.  Accordingly, when the electronic fetal monitor shows fetal heart rate abnormalities consistent with severe hypoxia, asphyxia and acidosis, delivery of the baby should occur as fast as safely possible.

Causes of Hypoxic-Ischemic Encephalopathy (HIE) and Birth Asphyxia

HIE can be caused by uterine, placental and umbilical cord complications during labor and delivery.

Uterine Complications:

Excessive uterine activity (tachysystole) can result in fetal hypoxia and ischemia during labor.  During uterine contractions blood flow to the fetus is dramatically reduced resulting in transient fetal hypoxia.  If uterine contractions are too close together, the fetus does not have the chance to recover adequate oxygenation from the placenta and can become hypoxic.  When a fetus is exposed to excessive uterine activity for prolonged periods of time, the fetal heart rate can drop dangerously low, resulting in fetal ischemia.  Uterine rupture can also cause HIE.  Women who have had a previous cesarean section are at an increased risk for uterine rupture during a trial of labor.

Placental Complications:

Placental abruption occurs when the placenta separates from the uterine wall. This results in severe and acute hypoxia and ischemia and can lead to brain damage if the fetus is not delivered emergently. Abnormalities of the attachment of the placenta to the uterine wall (placenta previa) can also cause HIE.

Umbilical Cord Complications:

Umbilical cord complications that interfere with the transfer of blood and oxygen to the fetus can also cause HIE. These complications include the cord being wrapped around the fetal neck, cord compression and umbilical cord prolapse.

Medical Negligence

The electronic fetal heart rate monitor will always show abnormalities of the fetal heart rate caused by hypoxia, ischemia and acidosis. The failure of the medical team (nurses, nurse midwives and obstetricians) to recognize these abnormalities and perform interventions to alleviate them or emergent delivery constitutes medical negligence.

HIE Treatment

Hypothermia therapy (brain cooling) is a relatively new treatment used to improve outcomes for HIE. The goal is to reduce the severity of the neurologic injury by minimizing brain swelling. Other treatments include endotracheal intubation and ventilation, seizure control and maintaining adequate blood pressure. Neonatal Intensive Care Unit admission is almost always required for the treatment of HIE.

How Does Hypothermia (Brain Cooling) Work?

During hypothermia the baby’s body temperature is dropped to approximately 91 degrees Fahrenheit for 72 hours. This helps slow the metabolic rate, allowing cells to recover over a longer period of time. This helps prevent further brain damage from occurring.

HIE Is Preventable

During labor, when a baby is being monitored with an electronic fetal heart rate monitor (EFM) and is being exposed to hypoxia, ischemia or acidosis, the EFM will always show abnormalities in the fetal heart rate, including minimal or absent fetal heart rate variability, late fetal heart rate decelerations, prolonged fetal heart rate decelerations, fetal heart rate tachycardia or bradycardia. When these fetal heart rate abnormalities occur, and especially in the setting of excessive uterine activity, it is essential that the obstetric personnel undertake interventions to treat the causes of fetal hypoxia, ischemia and acidosis in a timely fashion and if they cannot be eliminated, to deliver the fetus as fast as safely possible.

My Baby Was Diagnosed With HIE

If you suspect your baby’s HIE was preventable and was caused by medical negligence, be proactive about seeking legal counsel. The attorney you choose to represent your child should have extensive experience and success in representing babies who suffer the catastrophic consequences of HIE.

Do I Have A Case?


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I have so much heartfelt gratitude for Lancione & Lancione. John Lancione is nothing short of knowledgeable, readily accessible, and honest. Not only was his team professional and capable, but they were also genuine and compassionate. It was difficult reliving the facts of my daughter’s case, but I was able to see how diligently John worked on her behalf. His experience was invaluable at the critical moments, and we were fortunate to have this team representing us. While the circumstances of our case will always be hapless and emotionally tragic, John skillfully guided us through the process and led us to a satisfying outcome which affords my daughter with the on-going care she needs and me with the peace that I was seeking. Crystal Rinker

What Our Clients Say

John Lancione is an upstanding person. He has incredible passion for what he does and infinite knowledge of law. John and his team are personable and professional. My daughter was born with severe medical complications due to negligence, and the first time I contacted John’s law firm, I spoke directly with him. Within the next few days, John traveled to my home where we went over the details of my case. He was forthright and reviewed my case diligently. John and his firm were always reachable and got back to me quickly with any information. Although, this was a difficult time for my family, John made it positive. Whenever we would speak of my daughter, or when he would call just to see how she was doing, he always used her name. As small as that sounds, it is true to the type of person that he is. He always made me feel as though my daughter were more than just another case number; and that she is a human being. Incredible person!! I highly recommend him to anyone!!!!!!!! Amanda Green

$22 Million Dollar Settlement

A child who suffered severe brain damage resulting in Kernicterus, caused by the hospital’s failure to properly interpret bilirubin levels.

$15.5 Million Dollar Settlement

A baby boy who suffered brain damage and cerebral palsy due to nurses failing to notify obstetrician that the baby was experiencing fetal distress.

$14.2 Million Dollar Settlement

A baby girl who suffered brain damage and cerebral palsy due to nurse failing to follow hospital policy.

$12.6 Million Dollar Settlement

A baby girl diagnosed with cerebral palsy after obstetrician failed to respond to signs of fetal distress.

$9 Million Dollar Settlement

A child who suffered severe brain damage resulting in cerebral palsy. The child was delivered by emergency cesarean section following uterine rupture.

Birth Trauma
Causes Of Birth Injury
Cephalopelvic Disproportion Fetal Distress During Labor Infection
Midwife Error
Nonobstetric Surgery During Pregnancy
Obstetrical Nurse Negligence
Oxygen Deficiency
Placental Abruption
Premature Rupture Of Membranes
Prenatal Care Errors
Preterm Delivery
Uterine Ruptures
Dangerous Drugs Related To Birth Injury
Negligent High-Risk Birth Management
Advanced Maternal Age
Diabetes And Pregnancy
Premature Birth
Suspected Large Fetus
Twins, Triplets, Multiples
Birthing Complications
Drugs Used To Arrest Labor
Errors In Inducing Labor/Pitocin Errors
Fetal Monitoring During Labor
Forceps/Vacuum Extraction Delivery
Injuries From Delayed Birth Umbilical Cord Complications
Breech Birth
Brachial Plexus Injury
Erb’s Palsy
Shoulder Dystocia
Cerebral Palsy
Medical Negligence & Cerebral Palsy
Did Medical Malpractice Cause Cerebral Palsy?
Newborn Hypoxia & Asphyxia
Pediatric Brain Injury
Resources To Help Your Child With CP
Infant Seizures
Neonatal Intensive Care (NICU) Errors
Cord Blood Gas Tests
Untreated Jaundice
Future Of A Child With A Birth Injury
The Effects Of A Birth Injury As Your Child Ages
Cesarean Section Errors
Delayed C-Section
Emergency C-Section
Vaginal Birth After C-Section (VBAC)
Wrongful Death
Maternal Injuries During Birth
Excessive Bleeding/Hemorrhage
Maternal Infections After Giving Birth
Blood Clots/Thromboembolic Disease
Neonatal Jaundice, Hyperbilirubinemia and Kernicterus
hypoxic ischemic encephalopathy

Malpractice alert: If HIE is diagnosed, hypothermia treatment should be offered as this is a time critical issue, as long as all indications for the treatment are met. Failure to provide hypothermia treatment to an eligible baby in immediate need qualifies for malpractice. Can HIE be prevented? Two things matter the most:

  1. Constant monitoring: Observing the mother and baby at regular intervals is crucial, so distress is immediately detected and acted upon.
  2. Timely delivery: Once any abnormal signs are detected, delivering the baby is mission critical, especially in case of high-risk pregnancies.

Other proactive factors to consider:

  • Regular prenatal testing to check fetal health
  • High risk pregnancies should be managed by specialists
  • Fetal heart rate should be monitored the minute the mother is admitted for delivery so the labor and delivery team can be immediately alerted
  • Any uterine or placental complications should be detected and a C-section delivery should be conducted immediately. Failure to do so accounts for medical negligence.

The important thing to know about HIE is that it is preventable. If you suspect your baby’s HIE was preventable and was caused due to medical negligence, be proactive about seeking legal counsel. There are a few factors to consider –

  • Baby’s condition before oxygen deprivation
  • the severity of oxygen deficit
  • the length of time the baby was deprived of oxygen
  • medical management and care after

Legal point of view Below are some essential factors to consider:

  1. One thing that separates our practice from the rest is we work around your schedule and not the other way round.
  2. Being proactive about deadlines, filing the case well within the statue of limitations goes a long way.
  3. We consult with medical and financial experts to ensure you have all the information for your case.
  4. Ensuring a settlement that will factor in care required throughout the child’s lifetime.
  5. Understanding the intricacies of a trust fund to ensure your child is covered, as the settlement cannot be directly delivered in the child’s account.
  6. With our specialized focus on birth injury, you can depend on our excellence and expertise when it comes to navigate through the intricacies of the case every step of the way.

Get The Money You Need To Give Your Child The Resources He Or She Needs

If your child has been diagnosed with cerebral palsy, early intervention is critical. Enrolling your child in occupational therapy, physical therapy and speech therapy can help him or her maximize abilities. Talking to a lawyer is also a good idea if you need to ensure that your child’s cerebral palsy was not caused by medical negligence. We invite you to call our Rocky River offices at 440-331-6100 or contact us online to schedule an appointment with an Ohio spasticity lawyer. The Lancione Law Firm is proud to serve clients in Cincinnati, Columbus, Toledo, Akron, Youngstown and other communities throughout Ohio with the knowledge and experience of a well-qualified Cleveland cerebral palsy diagnosis attorney.

Representing Families Affected By Birth Injuries

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