Hypoxic brain injury claims for babies (HIE)

HIE (each letter is pronounced separately as H.I.E) is a commonly used abbreviation for hypoxic ischaemic encephalopathy. Hypoxia means lack of oxygen. Ischaemia means lack of blood supply to an area of the body. Encephalopathy means disease or damage affecting the brain.

Newborn babies who are diagnosed with HIE have suffered an injury to their brain from a disruption to their blood oxygen supply during pregnancy, labour, and delivery or immediately after birth. This can lead to cerebral palsy and neurodevelopmental disability.

Other medical terms, such as asphyxia or anoxia, are also used to describe brain injuries at birth from lack of oxygen.

HIE is a serious condition with long-term consequences for the child. There are different grades of HIE which indicate the severity of the injury to the brain.

Newborn babies who are suffering from HIE may show any of the following signs and symptoms in the first few hours or days of life:

• low APGAR scores;
• blue or pale skin colour;
• low heart rate;
• breathing (respiration) difficulties or grunting;
• fits (convulsions or seizures);
• problems with feeding;
• hypotonia (floppiness, reduced muscle tone);
• organ failure;
• abnormal response to light;
• abnormal level of consciousness;
• altered brain electrical activity.

Babies who have HIE often need help with breathing and may need resuscitation and ventilation immediately after birth. They require specialist neonatal care and may be transferred to the neonatal unit (SCBU, NNU or NICU).

If the baby has moderate or severe HIE, they will usually be treated with therapeutic hypothermia, also known as ‘controlled cooling’ or simply ‘cooling’.

In recent years it has become standard practise to treat babies who have suffered moderate or severe hypoxic ischaemic encephalopathy (HIE) birth injury with therapeutic hypothermia or ‘cooling’.

During cooling, the temperature of the baby’s brain is lowered from normal body temperature of 37 °C to between 33,5 °C and 34.5 °C. The cooling treatment must start no later than six hours after birth and continue for a period of 72 hours.

Cooling reduces brain swelling, intracranial pressure and brain cell metabolism, and the damaging compounds that are released by the brain cells after a hypoxic event, and increases the repair of brain cells. If correctly administered, cooling has been found to slow down the rate of damage that is caused to the brain from hypoxia (lack of oxygen) and can significantly reduce the injured baby’s physical disability.

Whilst timely treatment with cooling can reduce the more obvious physical disability from hypoxic brain injury at birth, it does not always provide a total cure to HIE brain injury. Cooled babies are sometimes left with ongoing subtle, neurological impairments from their HIE injury which only become evident in older childhood and teenage years when the child struggles to keep up at school. In these cases, the child and young adult may need significant care and support, both at school and as they transition into work and independent life.

The following tests are often used during the diagnosis of hypoxic brain injury or HIE:

Umbilical cord blood gas tests

As soon as a baby is born the midwives test samples of blood which they take from the blood vessels in the umbilical cord. The umbilical cord has one vein and two arteries. The vein takes food and oxygen from the mother (via the placenta) to the baby. The two arteries take the waste (including carbon dioxide, lactic acid) from the baby back to the placenta/mother. When a baby has been starved of oxygen in labour, the blood sample from the umbilical artery contains an abnormally high level of acid.

APGAR scores

Midwives use APGAR scores to check the newborn baby’s condition by rating their Appearance, Pulse, Grimace, Activity and Respiration, at one minute, five minutes and ten minutes of age. Each sign is given a score between zero and two, and the combined total score (out of ten) gives a general impression of the newborn baby’s health.

The APGAR score is less reliable than the umbilical cord blood test because it depends on the midwife’s observation of the baby. However, if a baby has low APGAR scores at five and ten minutes of life, this may indicate that they have HIE.

MRI brain scan

Where there is concern that a baby has suffered an injury to their brain, an MRI scan can identify which areas of the brain have been damaged. MRI brain scans are used to diagnose other conditions affecting the brain as well as HIE. The cause of the injury and its timing and severity can often be identified by the pattern of injury on the MRI scan of the baby’s brain.

Negligent mistakes by midwives and obstetricians (childbirth doctors) which can lead to HIE birth injury and hypoxic brain injury claims include:

• incorrect risk assessment of a pregnant woman;
• fetal monitoring errors;
• failing to call a doctor to review the mother following abnormal signs in labour;
• failing to recognise signs of abruption, uterine rupture, or hyperstimulation in labour;
• incorrect use of syntocinon/oxytocin in labour;
• poor delivery technique (shoulder dystocia, impacted fetal head, breech birth, twins);
• delayed delivery by forceps, ventouse suction or caesarean section.

Mistakes by midwives, neonatologists, paediatricians, and anaesthetists which can cause HIE after the birth of the baby and lead to hypoxic brain injury claims include:

• intubation, resuscitation, or ventilation errors;
• failing to clear meconium from the baby’s airway;
• failing to keep the baby’s airway clear during neonatal skin-to-skin contact;
• cooling errors.

HIE brain injuries are complex and can lead to a range of neurological impairments and disabilities. The full extent of each child’s disability and its impact on their future life may only become fully apparent as they grow and develop over time. In each case, we work with the family and a team of trusted experts to ensure that we understand the full extent of our client’s injury and disability. This allows us confidently to secure compensation settlements which will meet the child’s needs arising from their disability for the rest of their life.

Our clients with HIE birth injury often have one or more of the following injuries and disabilities:

• cerebral palsy brain injury or other severe neurological disability;
• difficulties with mobility and muscle movement or control;
• problems with sitting and posture;
• feeding and swallowing difficulties;
• impaired speech, language, and communication;
• blindness, deafness or sensory impairment;
• epilepsy;
• learning disability and special educational needs (SEN);
• behavioural problems;
• autism/ASD or ADHD.

Compensation claims for HIE birth injury are among the highest settlements that we achieve for our clients. This is because the compensation reflects not only the injury, but the lifelong cost of meeting the additional needs that arise from our client’s disability.

Following HIE birth injury, our clients’ settlements often include compensation for:

• pain, suffering and disability;
• costs of care (professional or provided by family);
• case management;
• therapies, such as:
  • physiotherapy;
  • occupational therapy (OT);
  • speech and language therapy (SALT);
  • hydrotherapy;
• specialist aids, equipment and assistive technology;
• adapted vehicles, wheelchairs and additional transport costs;
• increased costs of accommodation or home adaptations;
• support with special educational needs (SEN);
• loss of earnings and pension;
• medical costs;
• Court of Protection deputyship costs;
• other expenses arising directly from the child’s disability.

Visit our specialist cerebral palsy website for more information about compensation for children with HIE brain injury and cerebral palsy.