HIE Stages

hie stages

As parents await the arrival of a newborn, the excitement is often tinged with a touch of anxiety. Every parent hopes for a smooth delivery and a healthy baby. Unfortunately, complications during birth can lead to serious conditions like Hypoxic Ischemic Encephalopathy (HIE), a type of brain damage that occurs when an infant’s brain doesn’t receive enough oxygen and blood. Understanding the HIE stages is crucial for early intervention and treatment in order to minimize permanent brain damage.

For families in Chicago, the top Chicago birth injury attorneys at Curcio & Casciato stand ready to help navigate the complexities that come with HIE-related birth injuries. If you or your baby has suffered life-altering injuries during birth that were directly caused by negligence, you may have grounds to file a birth injury lawsuit. Call Curcio & Casciato at 312-321-1111 to schedule a free consultation.

What is Hypoxic Ischemic Encephalopathy (HIE)?

Hypoxic Ischemic Encephalopathy (HIE) falls under the medical umbrella of neonatal encephalopathy. It’s a serious neurological condition in newborns characterized by a shortage of oxygen (hypoxia) and reduced blood flow (ischemia) to the brain. This initial oxygen deprivation and lack of cerebral blood flow can lead to the death of brain cells and brain damage, which can occur before, during, or after childbirth. 

The severity of HIE can range significantly, depending on which of the HIE stages the child is in, with symptoms varying from mild to permanent, preventing a child’s normal brain development and quality of life.

Understanding HIE stages is crucial not only for medical professionals but also for parents and legal advocates who may be involved in addressing the consequences of the condition when it is linked to malpractice.

How Common is HIE in Newborns?

While advances in medical care have reduced the incidence of HIE, it still affects about 1.5 to 2.5 per 1,000 live full-term births in developed countries like the United States. Of those who receive an HIE diagnosis, approximately 40% to 60% either die or suffer significant disabilities by the time they reach 2 years old.

Premature infants are at a higher risk of birth asphyxia. The hypoxic-ischemic brain injury remains a significant cause of long-term disability and represents a crucial concern for health professionals and parents alike.

What Causes Lack of Blood Flow to a Baby’s Brain?

Neonatal Encephalopathy is the result of a reduction in the supply of oxygen and blood flow to an infant’s brain at or around the time of birth and potentially interrupts the delicate balance required for a newborn’s developing brain:

  • Umbilical Cord Problems: Issues such as a prolapsed cord, cord compression, or true knot can significantly hinder the baby’s oxygen supply.
  • Delivery Complications: Traumatic births or prolonged labor can lead to oxygen deprivation.
  • Placental Dysfunction: Conditions like placental abruption or placenta previa can disrupt blood flow to the baby.
  • Inadequate Fetal Monitoring: Failing to properly monitor the fetal heart rate during labor and delivery can lead to missed signs of distress and delayed intervention.
  • Infection: Maternal infections, including intra-amniotic infection (chorioamnionitis), can lead to systemic infections in the newborn, therefore leading to perinatal asphyxia.
  • Neonatal Stroke: A fetal stroke around the time of birth can cause HIE by disrupting blood flow to the brain.
  • Respiratory Distress: Premature babies may have underdeveloped lungs, leading to respiratory distress syndrome and subsequent oxygen deprivation.

Hypoxic Ischemic Encephalopathy Stages

The HIE stages are determined by the severity of the condition, assessed through clinical findings, and the Sarnat staging system. Hypoxic ischemic encephalopathy stages are graded based on the baby’s symptoms, including alertness, muscle tone, seizures, pupil size, respiration, and duration of the condition during the neonatal period. 

The Sarnat staging system is also used alongside a clinical and electroencephalographic study, which is used to measure the electrical activity in the baby’s brain. If the child’s HIE is severe, medical providers may also order a brain imaging scan, such as a magnetic resonance imaging (MRI), to see the extent of damaged brain cells.

HIE Stage 1: Mild HIE

In the initial phase of HIE, referred to as Mild HIE, infants may exhibit symptoms that are less pronounced and more challenging to detect. These can include a subtle state of over-alertness or marked irritability, slight difficulty with initiating or maintaining sleep, and minor feeding challenges such as poor sucking or latch-on abilities. Infants may also demonstrate reduced muscle tone.

Most infants with Mild HIE typically experience a full recovery and go on to have little to no developmental delays, neurological deficits, or further injury. Nonetheless, vigilance is crucial, as early detection and management can ensure better neurodevelopmental outcomes for affected newborns.

HIE Stage 2: Moderate HIE

When newborns progress to Stage 2 of a hypoxic-ischemic injury, the symptoms become more apparent and concerning. Infants may display a marked decrease in alertness, showing signs of lethargy and diminished responsiveness to stimuli.

Physical manifestations might include persistent episodes of apnea or bradycardia. Feeding difficulties escalate. Seizure activity may emerge within the first 24 to 48 hours after the hypoxic-ischemic event.

Although the prognosis in moderate HIE is guarded, with appropriate therapeutic interventions, some infants can still achieve significant recovery. However, they are at a higher risk for significant developmental and neurological complications later in life.

HIE Stage 3: Severe HIE

Severe HIE represents the most critical level of hypoxic-ischemic encephalopathy, where newborns endure profound neurological disturbances. With severe HIE, infants may have little to no neonatal reflexes. Infants could even be in a state of coma or stupor with abnormally slack muscle tone. 

Severe HIE is often accompanied by a complete failure to breathe independently, necessitating immediate respiratory support, as well as a high risk of persistent seizures that are resistant to conventional anticonvulsant therapy.

The prognosis of severe HIE is grave, with a high likelihood of substantial long-term neurological disabilities and/or a significant risk of mortality. With severe HIE, ongoing, comprehensive medical care is critical for managing the complex needs of these infants.

Neonatal Brain Injury Treatments

Effective treatment for Hypoxic Ischemic Encephalopathy (HIE) is time-sensitive and requires a multidisciplinary approach to optimize outcomes. Here are the treatments used in the typical neonatal intensive care unit (NICU):

Therapeutic Hypothermia

Therapeutic hypothermia is the primary treatment for moderate to severe HIE. By cooling the body or brain to a few degrees below normal temperature for 72 hours, therapeutic hypothermia has been shown to reduce brain dysfunction.

Mechanical Ventilation

To ensure enough oxygen, mechanical breathing support may be necessary for babies with respiratory difficulty.

Seizure Management

Anticonvulsant medications may be used to control seizures, which are common in advanced HIE stages.

Nutritional Support

Feeding tubes or IV nutrition may be needed to manage feeding problems while the baby recovers.

Physical Therapy

Early intervention with physical therapy can support motor development and mitigate potential long-term disabilities.

Continuous monitoring of vital signs and neurological status is critical to adjust treatments as needed. Each HIE case requires a tailored approach to improve the prognosis for infants with HIE.

Long-Term Effects of HIE

The long-term effects of Hypoxic Ischemic Encephalopathy (HIE) in newborn infants can be far-reaching, varying in severity depending on the extent of the brain injury.

Those with mild HIE have the best quality of life, while those with moderate to severe HIE suffer lifelong mental retardation and/or death. Some of the potential long-term effects include:

  • Cognitive Impairments: These may range from mild learning disabilities to severe cognitive disabilities, affecting a child’s ability to process information, learn, and problem-solve.
  • Motor Skill Delays: Difficulty with coordination and muscle control, such as cerebral palsy, can impact a child’s ability to sit, stand, walk, or perform fine motor tasks.
  • Epilepsy: There’s an increased risk of developing epilepsy or other seizure disorders following an HIE diagnosis.
  • Vision and Hearing Problems: Sensory impairments are also common, potentially leading to challenges with communication and education.
  • Behavioral Issues: Children with a history of HIE may exhibit behavioral or emotional challenges, which can manifest as attention deficit, impulsivity, or social difficulties.

If your child suffers from cerebral palsy as a result of HIE, you may be eligible for compensation. Contact a Chicago cerebral palsy attorney today.

Can You Sue for HIE?

Yes, you can sue if your child’s HIE is suspected to have been caused by malpractice. When healthcare providers fail to meet the standard of care during pregnancy, labor, delivery, or postpartum management, and this failure results in HIE, it may constitute medical malpractice. 

To establish a claim, you must demonstrate that the medical providers deviated from accepted medical practices, which directly caused the HIE. Typical scenarios include failure to monitor fetal distress, delay in performing a necessary cesarean section, or improper management of the baby’s condition post-delivery. 

We dive into this more here: how to sure a hospital for negligence.

Each case requires a thorough examination of medical records, expert testimonies, and an understanding the legal complexities involved in birth injury claims. Seeking the counsel of an experienced birth injury attorney at Curcio & Casciato can help determine if you have a valid case.

Birth Injury Damages

When a child suffers from Hypoxic Ischemic Encephalopathy (HIE) due to medical negligence, the family may be entitled to significant compensation for birth injury damages.

Economic damages are those that have clear monetary value, including:

  • Medical expenses
  • Expenses for specialized equipment, home modifications for disability access, and special education needs
  • Full-time caregiver expenses
  • Lost wages of the parents
  • Loss of earning capacity of the child, if they suffer severe disabilities

Meanwhile, non-economic damages are those that don’t have monetary value, including physical pain and suffering, emotional distress, and loss of life’s enjoyment. 

In severe cases, if the HIE birth injury leads to a child’s passing, families may pursue wrongful death claims. A Chicago wrongful death attorney at Curcio & Casciato also has what it takes to handle fatal birth injury cases.

Chicago Birth Injury Attorneys for HIE Injuries

If your child has been diagnosed with HIE and you believe medical negligence played a part in the causation, you have the right to seek justice and compensation.

We’re dedicated to providing compassionate, expert legal representation to help secure the resources needed for your child’s care and future.

Contact our Chicago medical malpractice lawyers today at 312-321-1111 to discuss your case and explore your options. Our knowledgeable attorneys can guide you through the complexities of a medical malpractice lawsuit and fight for the compensation your family deserves.

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