Hypoxic-ischemic encephalopathy (HIE) is one of the most devastating birth injuries a family can face. When a baby’s brain is deprived of oxygen during labor and delivery, the resulting damage can cause lifelong disabilities including cerebral palsy, intellectual impairment, and seizure disorders. In many cases, HIE is preventable when medical providers follow established standards of care.
What Is Hypoxic-Ischemic Encephalopathy?
Hypoxic-ischemic encephalopathy occurs when a baby’s brain doesn’t receive enough oxygen (hypoxia) and blood flow (ischemia) during or around the time of birth. The term “encephalopathy” refers to the brain dysfunction that results from this oxygen deprivation.
HIE affects approximately 1.5 to 2.5 per 1,000 live births in the United States. While some cases result from unavoidable complications, many occur because medical providers fail to recognize signs of fetal distress, delay necessary interventions, or mismanage labor and delivery.
How Oxygen Deprivation Damages the Brain
The developing brain is extremely vulnerable to oxygen deprivation. When blood flow and oxygen delivery are interrupted, brain cells begin to die within minutes. The severity of damage depends on:
- Duration of oxygen deprivation – Longer periods cause more extensive damage
- Degree of hypoxia – Complete oxygen deprivation is more harmful than partial
- Gestational age – Premature babies may be more vulnerable
- Speed of intervention – Rapid response can limit damage
- Cooling therapy – Therapeutic hypothermia within 6 hours can reduce injury severity
Brain damage from HIE occurs in two phases. The primary injury happens during the hypoxic event itself. A secondary injury phase follows over the next hours and days as inflammation, cell death cascades, and other processes continue damaging brain tissue—which is why prompt cooling therapy is so critical.
Common Causes of HIE
Multiple obstetric emergencies can lead to oxygen deprivation and HIE:
Umbilical Cord Problems
- Umbilical cord prolapse – The cord slips through the cervix before the baby, becoming compressed
- Cord compression – The cord is squeezed during contractions or by the baby’s position
- Nuchal cord – The cord wraps around the baby’s neck
- True knot – The cord becomes knotted, restricting blood flow
Placental Complications
- Placental abruption – The placenta separates from the uterine wall before delivery
- Placenta previa with hemorrhage – Bleeding from abnormally positioned placenta
- Placental insufficiency – The placenta fails to deliver adequate oxygen and nutrients
Labor and Delivery Complications
- Prolonged labor – Extended labor causing fetal distress
- Uterine rupture – Tearing of the uterus, especially during VBAC attempts
- Shoulder dystocia – Baby’s shoulder becomes stuck, delaying delivery
- Delayed emergency C-section – Failure to perform timely cesarean when indicated
Maternal Conditions
- Maternal hemorrhage – Severe bleeding reducing blood flow to baby
- Maternal hypotension – Dangerously low blood pressure
- Maternal infection – Chorioamnionitis or other infections
- Uterine hyperstimulation – Excessive contractions from Pitocin administration
Recognizing Signs of Fetal Distress
Electronic fetal monitoring provides crucial information about how a baby is tolerating labor. The American College of Obstetricians and Gynecologists (ACOG) establishes standards for interpreting fetal heart rate patterns. Warning signs that should prompt immediate intervention include:
- Category III fetal heart rate patterns – Absent variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia
- Prolonged bradycardia – Sustained heart rate below 110 beats per minute
- Late decelerations – Heart rate drops after contractions, indicating placental insufficiency
- Absent variability – Lack of normal beat-to-beat fluctuation
- Sinusoidal pattern – Smooth, wave-like pattern associated with severe fetal anemia
When these warning signs appear, medical providers must act quickly. Failure to recognize or respond to fetal distress is one of the most common forms of medical negligence in HIE cases.
HIE Severity Classifications
HIE is classified into three severity levels based on clinical findings:
Mild HIE (Stage 1) – Symptoms include hyperalertness, mild muscle tone changes, and possible feeding difficulties. Most babies with mild HIE recover without permanent disability, though subtle learning difficulties may emerge later.
Moderate HIE (Stage 2) – Symptoms include lethargy, significant hypotonia (decreased muscle tone), decreased reflexes, and possible seizures. About 20-40% of babies with moderate HIE develop significant long-term disabilities.
Severe HIE (Stage 3) – Symptoms include coma, flaccid muscle tone, absent reflexes, and frequent seizures. Severe HIE carries high mortality rates, and survivors typically have profound disabilities including severe cerebral palsy, intellectual disability, and epilepsy.
Therapeutic Hypothermia: The Standard Treatment
Therapeutic hypothermia (cooling therapy) is now the standard treatment for moderate to severe HIE. This treatment involves lowering the baby’s body temperature to 33.5°C (92.3°F) for 72 hours, which slows the secondary brain injury process.
Critical requirements for cooling therapy:
- Must begin within 6 hours of birth for maximum benefit
- Baby must meet specific criteria (gestational age, severity of injury)
- Requires specialized NICU with trained staff
- Careful monitoring throughout treatment period
Studies show cooling therapy reduces death and major disability by approximately 25% in eligible infants. However, the narrow treatment window means that delays in recognizing HIE or transferring babies to appropriate facilities can eliminate this life-saving option.
Long-Term Effects of HIE
Children who survive HIE may face lifelong challenges:
- Cerebral palsy – Motor impairments ranging from mild to severe
- Intellectual disability – Cognitive impairments affecting learning and daily functioning
- Epilepsy – Seizure disorders requiring ongoing medication
- Visual impairments – Including cortical visual impairment
- Hearing loss – Ranging from mild to profound
- Feeding difficulties – Requiring feeding tubes or specialized nutrition
- Behavioral and emotional disorders – ADHD, autism spectrum features, anxiety
The lifetime cost of caring for a child with severe HIE-related disabilities can exceed $10 million, including medical care, therapy, special education, adaptive equipment, and home modifications.
Medical Negligence in HIE Cases
Many HIE cases result from preventable medical errors. Common negligence includes:
- Failure to properly monitor fetal heart rate – Not using electronic fetal monitoring or ignoring concerning patterns
- Delayed response to fetal distress – Waiting too long to intervene when warning signs appear
- Delayed emergency C-section – Failing to meet the ACOG standard for timely cesarean delivery
- Pitocin mismanagement – Causing uterine hyperstimulation that compromises blood flow
- Failure to recognize umbilical cord problems – Missing signs of cord prolapse or compression
- Delayed cooling therapy – Missing the 6-hour window for therapeutic hypothermia
Proving an HIE Malpractice Case
Under the Illinois Medical Malpractice Act (735 ILCS 5/2-622), birth injury claims require:
- Certificate of merit – A qualified physician must review the case and certify there’s reasonable cause to believe malpractice occurred
- Expert testimony – Medical experts must establish the standard of care, breach, and causation
- Demonstrated damages – Documentation of the child’s injuries and future care needs
HIE cases typically require extensive review of fetal monitoring strips, medical records, nursing notes, and hospital protocols. Expert witnesses in obstetrics, neonatology, pediatric neurology, and life care planning help establish negligence and damages.
Contact an Illinois HIE Birth Injury Attorney
If your child suffered HIE and you believe medical negligence played a role, you need attorneys who understand these complex cases. At Phillips Law Offices, we work with leading medical experts to investigate birth injuries, and we fight to secure compensation that covers your child’s lifetime care needs.
Contact Phillips Law Offices at (312) 598-0917 for a free, confidential consultation. We handle birth injury cases on contingency—you pay nothing unless we recover compensation for your family.