Neonatal encephalopathy is a clinical diagnosis made when an infant’s neurological function is disturbed. Put simply, neonatal encephalopathy means your baby has suffered a brain injury.
Hypoxic ischemic encephalopathy (HIE) is a form of neonatal encephalopathy that occurs when an infant’s brain is deprived of oxygen before, during, or after birth. The longer the brain is without oxygen, the greater the likelihood of permanent brain damage and severe, lifelong disabilities. HIE is a birth injury that is often associated with medical malpractice.
Unfortunately, there is no cure for neonatal encephalopathy. Instead, the treatment options focus on reducing the risk of permanent brain damage through therapeutic hypothermia (cooling therapy). Later, a child who has been diagnosed with HIE may receive therapies and other treatments that address the specific signs and symptoms of their conditions.
HIE Therapies
If a doctor or other medical professional notices signs of HIE shortly after birth, then they will likely order a course of therapeutic hyperthermia (which may also be referred to as cooling therapy). Whole-body cooling therapy or selective head cooling is the only current treatment option for neonatal hypoxic-ischemic encephalopathy.
Therapeutic hypothermia must be administered within 6 hours of birth in order for it to be successful. Doctors must also confirm that the signs and symptoms that the baby is showing are due to swelling of the brain, or neonatal encephalopathy, and hypoxia (low oxygen). The baby must also be at least 36 weeks gestational age.
Cooling therapy addresses the effects of an injury caused by an hypoxic-ischemic event: swelling to the brain. When the brain is deprived of oxygen, brain cells begin to die. After oxygen is restored, the brain typically swells as a result of the original injury. This swelling can lead to further death of brain cells.
The goal of hypothermia therapy is to reduce the infant’s body temperature to 32.8 degrees Celsius. This can be done by using a cooling cap for selective head cooling or cooling the baby’s entire body using whole-body cooling. Once this temperature is achieved, it will be maintained for a period of 72 hours. Afterward, the infant is brought back to a normal body temperature over a period of 6 to 8 hours.
Reducing an infant’s body temperature after a hypoxic-ischemic encephalopathy incident slows the metabolic rate, giving the cells time to recover. This can prevent the spread and severity of brain damage. It may also reduce the likelihood of reperfusion injury, which happens when blood flow is restored to the brain too quickly.
While therapeutic cooling has a high rate of success in reducing the damage caused by neonatal hypoxic-ischemic encephalopathy, it may not be appropriate in all situations. In addition, some neonatal intensive care units (NICUs) are not equipped with the appropriate equipment to provide therapeutic hypothermia as a treatment option. Failure to administer cooling therapy may be a form of medical negligence.
HIE Treatments
The only immediate treatment currently available for hypoxic-ischemic encephalopathy is therapeutic hypothermia. After that, the treatment will depend on the severity of the brain damage and the area of the brain that is affected.
HIE is commonly associated with a number of medical conditions, including cerebral palsy. Babies who suffer a hypoxic-ischemic brain injury may also suffer from neurological, behavioral, and developmental issues, sensory challenges, and/or seizures.
Treatment options for children who suffered brain damage from neonatal encephalopathy include:
- Physical therapy (PT) to develop motor skills, which may include learning to walk, increasing strength, or improving flexibility.
- Occupational therapy (OT) to develop fine motor skills and learn to complete daily tasks, such as brushing teeth and feeding themselves. OT may also focus on visual perception and cognitive abilities as well as handling sensory issues.
- Speech or language pathology to help children form words, speak clearly, and/or process language. It may also be used for swallowing problems (dysphagia)
- Behavioral or emotional therapy to help children with HIE learn to process and deal with their emotions, communicate effectively, and develop or improve social skills.
- Massage therapy to relax tight muscles, reduce pain, improve circulation, and alleviate stress.
- Stem cell therapy, which is still in clinical trials, may involve injecting stem cells into injured tissues to help them heal.
- Other therapies, such as equine therapy, music therapy, or adaptive sports, to help children enjoy recreational activities and gain physical and social benefits.
Some conditions, such as cerebral palsy, may have additional treatment options. This may include medications and even surgery to help address the signs and symptoms of the condition.
What Parents Need to Know
Dealing with HIE can be challenging. It can often be difficult to accept that – other than therapeutic hypothermia – there is little that can be done to treat neonatal encephalopathy. However, in the months and years after this type of birth injury, you can take steps to treat the symptoms of your child’s condition.
HIE is often linked to medical malpractice. If you believe that your child’s doctor or other medical professional was negligent in some way – such as failing to monitor the fetus for signs of distress during labour and delivery – you may be able to file an HIE lawsuit against the at-fault party.
In addition to the above treatment options, there are a number of adaptive technologies, special education programs, and home modifications that can be utilized to improve the quality of life of a child who suffered brain damage from HIE. Affording some of these technologies and devices can be difficult. An HIE lawyer can help you get the compensation that you need to provide these services and devices for your child.
HIE Caused By Medical Negligence
HIE is not always preventable. However, there are many situations where a failure to properly monitor a mother during pregnancy or a baby during the birthing process leads to neonatal hypoxic-ischemic encephalopathy. Similarly, failing to intervene promptly or treat a suspected case of HIE can be a form of medical malpractice.
If your baby suffered a birth injury due to HIE during, pregnancy or labour, then the case should be considered by a team of experienced birth injury lawyers. Contact BILA today at 1-800-300-BILA or via our online contact form for more information about a potential legal claim and to discuss your child’s birth injury case.
What Are the Long-Term Effects of HIE?
A baby with neonatal encephalopathy may have few long-term effects if the oxygen deprivation was for a relatively short time and they were treated with cooling therapy shortly after birth. However, if cerebral blood flow was restricted for a longer period of time, they may suffer more permanent brain damage. This is often linked with conditions like cerebral palsy and epilepsy.
If you believe that your child’s HIE was a result of medical malpractice, you may be able to file an HIE lawsuit against the responsible medical provider. Reach out to BILA to schedule a free consultation with an experienced birth injury lawyer.
What Is the Most Appropriate Intervention for HIE?
If a doctor suspects that a baby has HIE due to a low Apgar score or other indicators, then the best possible treatment is therapeutic hypothermia. Lowering the baby’s body temperature for a period of 3 days can reduce the risk of further brain damage caused by swelling. It is the most effective intervention for a hypoxic-ischemic brain injury.
A failure to administer cooling therapy where appropriate may be a form of medical malpractice. If you believe that your baby suffered greater neuronal cell death because they were not treated with cooling therapy, you may be able to file a medical malpractice lawsuit. Call BILA to schedule a free consultation with a birth injury lawyer in your province.
Related: Causes of HIE
