Understanding Hypoxic-Ischemic Encephalopathy (HIE) In to Medical Negligence
Hypoxic-Ischemic Encephalopathy (HIE) is a serious brain condition caused by a lack of oxygen (hypoxia) and blood flow (ischemia) to the brain, often during childbirth. This condition can result in long-term disabilities, including cerebral palsy, developmental delays, and in severe cases, death. Early treatment is critical to minimize brain damage and improve outcomes. While there is no cure for HIE, several interventions can help manage the condition and prevent further injury.
While not all cases of HIE are preventable, sometimes poor obstetric care can play a role in its occurrence. Similarly, sometimes poor neonatal care can exacerbate, rather than minimise the damage caused by HIE.
Understanding HIE and how medical negligence might contribute is vital for ensuring accountability and improving healthcare outcomes.
WHAT IS HIE?
HIE occurs when the brain is deprived of adequate oxygen and blood flow for a prolonged period. The condition can develop during pregnancy, labour and delivery, or shortly after birth. Newborns with HIE often show symptoms such as:
• Low Apgar scores
• Difficulty breathing
• Acidotic blood gas
• Poor muscle tone
• Seizures
• Organ dysfunction (e.g., kidney or liver issues)
The severity of HIE is typically categorized into three levels—mild, moderate, and severe—depending on the extent of brain injury and the symptoms exhibited.
HOW MEDICAL NEGLIGENCE CAN CONTRIBUTE TO HIE
Medical negligence refers to a failure by healthcare providers to meet the standard of care expected in a given situation. In the context of HIE, negligence can occur at various stages of care:
1. Failure to Monitor Foetal Distress
Healthcare providers are responsible for closely monitoring the baby’s heart rate during labour and delivery. Abnormal patterns, such as bradycardia (a dangerously low heart rate), can indicate foetal distress and require immediate intervention. Delays in recognizing or responding to these signs can lead to prolonged oxygen deprivation.
2. Delayed Decision for Emergency C-Section
If complications arise during labour that place the baby at risk of oxygen deprivation, an emergency caesarean section (C-section) may be necessary. Failing to perform a C-section in a timely manner can extend the period of oxygen deprivation, increasing the likelihood of HIE.
3. Improper Use of Delivery Tools
The improper use of tools such as forceps or vacuum extractors during assisted deliveries can cause trauma to the baby’s head, potentially worsening oxygen deprivation or causing additional injuries.
4. Failure to Address Maternal Conditions
Maternal health issues like high blood pressure or infections require careful monitoring and management during pregnancy. Failure to address these conditions can increase the risk of placental problems or preterm labor, which can contribute to HIE.
5. Inadequate Resuscitation of the Newborn
After birth, some babies may require immediate resuscitation or other interventions to restore oxygen levels. Delays or errors in providing such care can exacerbate brain injury.
6. Delay to Promptly & Appropriately Treat the Symptoms of HIE
The timing in respect of treatment of HIE is absolutely critical to halt the spread of the damage in the brain cells. Please see the below paragraph in respect of how HIE should be managed by the neonatal team.
TREATING HIE
In Ireland, babies who are at risk of HIE should be monitored closely by the neonatal team for any signs that such an injury has occurred. If a baby is found to have HIE, they are transferred to the NICU in a large children’s or maternity hospital for prompt treatment. This treatment includes:
1. Therapeutic Hypothermia
Therapeutic hypothermia, or whole-body cooling, is the standard treatment for moderate to severe HIE. This involves cooling the baby’s body or head to about 33.5°C for 72 hours. The cooling process slows the brain’s metabolism, reducing inflammation and preventing the spread of brain injury. After 72 hours, the baby is slowly rewarmed to normal body temperature. An neonate with HIE should be cooled ASAP. There is only a window of 7 hours from the time of birth to commence cooling treatment, and even at that, the earlier the cooling commences, the better the outcome is.
2. Respiratory Support
Respiratory support, including supplemental oxygen or mechanical ventilation, ensures the baby receives adequate oxygen while their body recovers.
3. Seizure Management
Seizures are a common symptom of HIE. Anti-seizure medications such as phenobarbital are often administered to control seizures and prevent further brain injury.
4. Monitoring and Support for Organ Function
HIE can affect other organs, including the heart, liver, and kidneys. Continuous monitoring and supportive care, such as intravenous fluids and medications, are used to maintain organ function and stabilize the baby.
5. Nutritional Support
Newborns with HIE may have difficulty feeding. In these cases, nutrition is provided through intravenous fluids or a feeding tube until the baby is strong enough to feed orally.
6. Long-Term Follow-Up and Care
After the acute treatment phase, babies with HIE often require long-term care to address developmental delays or disabilities. Early intervention therapies, such as physical, occupational, and speech therapy, play a crucial role in supporting their development.
PROVING MEDICAL NEGLIGENCE IN HIE CASES
In legal cases involving HIE, the burden of proof typically falls on the claimant to show that medical negligence occurred and directly caused or worsened the condition. This involves establishing the following:
1. Duty of Care: The healthcare provider owed a duty of care to the mother and baby.
2. Breach of Duty: The provider failed to meet the expected standard of care.
3. Causation: The breach of duty directly resulted in HIE.
4. Damages: The baby suffered harm or injury as a result.
Reports obtained from expert doctors are essential to establish whether the medical team acted appropriately under the circumstances.
CONCLUSION
While HIE can occur due to factors beyond anyone’s control, medical negligence can sometimes play a critical role in its development. When healthcare providers fail to recognise or address complications in a timely manner, the consequences can be devastating for both the child and their family. Prompt treatment of HIE, particularly therapeutic hypothermia, can significantly improve outcomes and limit long-term damage. Continued monitoring and supportive care are essential for addressing complications and giving affected newborns the best chance at a healthier future.
Families affected by HIE should seek legal advice to understand their options. In doing so, they can secure necessary resources for their child’s care and help drive improvements in medical practices to prevent future cases.
We at McMahon Goldrick Solicitors, specialise in representing children who have sustained HIE. We have successfully settled 100% of our cases against the HSE in relation to birth injury cases.
Due to the small & specialist nature of our firm, we have the ability to spend the necessary time to do a thorough examination of the medical records in a potential new HIE matter, and we continuously educate ourselves on the new & emerging recommended best obstetric & neonatal care practices
The settlement monies which have been awarded to our clients has been used to improve their lives greatly. Accessible housing has been built, private nursing care has been implemented, and specialist & private multidisciplinary care (inc. physio, speech & language, OT) has been implemented into their daily lives.
If you would like any further information on possibly bringing about a case on behalf a child with a HIE injury, please feel free to call us on 01 677 0044. Alternatively, please send an email to Grace – grace.carroll@rmcm.ie, or Ralph – ralph.mcmahon@rmcm.ie.
