Cerebral palsy and hypoxic brain injury caused by lack of oxygen to a baby’s brain around the time of birth are our clients’ most common claims from negligent maternity and neonatal care.
Hypoxic brain injury is devastating and can cause permanent, severe, physical and intellectual disability, ranging from learning and behavioural difficulties to complete dependence on others for all daily needs and full-time care.
For over 30 years, Boyes Turner’s hypoxic brain injury specialists have helped children and families affected by hypoxic brain injury obtain life-changing compensation to pay for care, adapted accommodation, therapies, specialist equipment, special educational support and guaranteed provision for the child’s lifelong needs.
Contact our medical negligence solicitors
If you think that your child may have suffered a brain injury as a result of negligent maternity or neonatal care around the time of their birth, or if you have been contacted by MNSI or NHS Resolution, we strongly recommend that you contact our birth injury solicitors for free, confidential advice straight away. HIE birth injury claims must be handled by claimant specialist solicitors to protect your child’s full entitlement to compensation.
We will ask you to tell us briefly about your child’s birth and their injury, and advise you about whether we can help you begin your claim and any time limits that apply. Your solicitor will discuss with you how your claim will be funded and advise how that works and what it will mean for you. We offer a range of funding options, but most of our clients’ claims are handled on a ‘no win no fee’ basis.
Once we have gathered the necessary evidence for your claim to proceed, we will notify the healthcare provider (usually represented by NHS Resolution) of your claim. We aim to make NHS Resolution accept full responsibility for your child’s injury as quickly as possible, so that we can obtain interim payments to help your family move to more suitable accommodation or adapt your home, and pay for the care, therapies and educational support that your child needs.
If the healthcare provider or their legal representatives at NHS Resolution deny liability, we will advise you about the best way to proceed with your claim. This may involve issuing court proceedings or inviting NHS Resolution to enter into settlement negotiations or mediation.
Partner, Medical negligence
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.
Newborn babies who have suffered an HIE birth injury may show any of the following signs in the first few hours or days of life:
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).
Babies with moderate or severe HIE birth injury will usually be treated with cooling (also known as therapeutic hypothermia).
Cooling or therapeutic hypothermia is a standard treatment for babies who have suffered moderate or severe HIE birth injury (hypoxic ischaemic encephalopathy).
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, brain cell metabolism and the damaging compounds that are released by the brain cells after a hypoxic event, and helps brain cells to heal. 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 for HIE brain injury. Cooled babies are sometimes left with ongoing subtle, neurological impairments from their HIE injury, such as behavioural and learning difficulties, which only become evident in older childhood and teenage years. 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:
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. Newborn babies with signs of recent hypoxia at birth are sometimes described as ‘acidotic’.
Umbilical cord blood gas results are often helpful in proving perinatal hypoxia in HIE birth injury claims.
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 suffered from hypoxia around the time of birth.
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) during pregnancy and birth which can lead to HIE brain injury claims include:
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:
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 types of disability:
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:
Visit our specialist cerebral palsy website for more information about compensation for children with HIE brain injury and cerebral palsy.
All NHS maternity services must report to the Maternity and Newborn Safety Investigations (MNSI) programme when a newborn baby is diagnosed with moderate or severe HIE or needs cooling.
The healthcare team must tell the baby’s family that they have reported their baby’s HIE birth injury to MNSI, and ask for their consent before sharing the family’s contact details with MNSI.
MNSI must ask for the family’s consent before accessing the mother and baby’s medical records so that they can investigate the maternity and neonatal care that the mother and baby received. Families do not have to give their consent, but if they do, and an investigation takes place, MNSI will share their findings with the baby’s parents, the hospital, and with the NHS’ claims defence team at NHS Resolution.
NHS Resolution are the NHS’ legal claims defence team. Their purpose is to reduce the number of medical negligence claims that are made against the NHS, and to minimise the compensation that is paid to injured patients. After birth injury, they do this in a number of ways, often starting with getting ahead of the claim in order to prepare their defence, and influencing the parents of injured children before they have obtained their own legal advice from an independent claimant specialist birth injury solicitor.
NHS Resolution receive notification from NHS maternity services and MNSI of every HIE birth injury which could result in a negligent birth injury, neonatal brain injury or maternal death claim. NHS Resolution then contact the family via their Early Notification (EN) scheme giving the impression that they can determine and advise them about their child’s eligibility for compensation, During their discussions with the (unrepresented) family they gather information which is actively used to prepare their defence to any later claim.
Data relating to the Early Notification scheme shows that, in the vast majority of cases so far, NHS Resolution has ultimately denied full liability and the only families who have received compensation under the scheme are those who were represented by their own, independent solicitor. Evidence also suggests that in the very rare cases where NHS Resolution have made interim payments to families, these payments fall far short of the compensation that the child would receive if they were represented by our specialist solicitors in a birth injury negligence claim.
Our HIE birth injury specialists have extensive experience of handling cerebral palsy, birth injury and neonatal brain injury claims for injured children against NHS Resolution. Most of the high value compensation cases that we win for our clients began with NHS Resolution denying that negligent NHS maternity care was responsible for the child’s injury, and would not have succeeded if our clients had accepted NHS Resolution’s assessment of their claim.
If you have been contacted by NHS Resolution, we strongly recommend that you contact our HIE birth injury specialists for independent legal advice and support. Your call will be handled, free of charge and confidentially, by an experienced birth injury solicitor.
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In what can only be described as a stressful process dealing with Birth Negligence for your child, Boyes Turner, specifically Richard Money Kyrle and Tara Byrne made the process as smooth, efficient, and with a high level of understanding and empathy as possible. Each part of the process was explained clearly in layman's terms so I had a clear idea of what to expect and also a timeline of how long each process would take. Both Richard and Tara were always an email or phone call away and having to divulge such past traumatic events was done with the utmost respect and empathy. My son's case has now settled and thanks to all the hard work and fighting for justice we are able to move towards a bright future.
