Perinatal Asphyxia Attorneys in Philadelphia

Hypoxic-Ischemic Encephalopathy

One of the most common injuries that occurs from a lack of oxygen to the brain is hypoxic-ischemic encephalopathy, or HIE, which can cause further serious impairments like developmental delay, cognitive impairments, and cerebral palsy.

You always do your best to protect your children as a parent. Unfortunately, infant asphyxia is often due to failures on the part of the healthcare providers entrusted with a child’s safety. On the other hand, the responsibility for paying the massive medical bills associated with prolonged medical care and ongoing health treatments falls on the child’s family. The financial and emotional stress that asphyxia injuries bring are often life-changing, and can be difficult to recover from.

What Is Perinatal Asphyxia?

Birth asphyxia is a dangerous medical condition caused by a lack of oxygen being able to reach the brain. This oxygen depletion harms the baby in the form of brain injuries like hypoxic-ischemic encephalopathy and intracranial hemorrhage. It can also cause health problems like hypoglycemia and respiratory distress.

The threat of hypoxic-ischemic encephalopathy is especially dangerous. Oxygen deprivation as a result of asphyxia can quickly damage brain tissue. Also known as HIE, hypoxic-ischemic encephalopathy is a condition that is the leading cause of severe impairments for infants. HIE can cause conditions including epilepsy, delayed motor skills, cerebral palsy, and cognitive impairment.

Causes of Perinatal Asphyxia

There are a number of circumstances that can cause a baby to become oxygen-deprived around the time of delivery:

• Umbilical cord complications: Umbilical cord prolapse and the cord being wrapped about the baby’s neck can cause the flow of oxygen to be cut off, leading to oxygen deprivation.
• Pre-eclamsia: If a mother is diagnosed with high blood-pressure during her pregnancy, this can cause decreased blood flow to the baby.
• Emergency c-section delay: Complications during labor often require a quick delivery via c-section. If this procedure is delayed for any reason, it can mean the baby will be deprived of oxygen for too long.
• Placental abruption: This occurs when the placenta separates from the uterine wall, causing severe bleeding and loss of blood flow to the baby.
• Improper anesthesia administration: Mistakes can cause problems with the mother’s blood pressure, interfering with blood flow to the baby, leading to HIE.

Many complications leading to infant asphyxia can be managed if the medical team is monitoring the infant properly and takes the correct steps to limit their exposure to injury. Unfortunately, this isn’t always the case. If the care team doesn’t interpret the fetal heart monitor properly they may miss the problem, and they may not take the proper steps due to improper training or oversight and negligence on the part of senior staff due to factors like fatigue.

When Is HIE Most Likely To Occur?

HIE can develop at different stages, due to different causes.

HIE can develop during pregnancy because of:

• Preeclampsia
• Maternal diabetes
• Blood flow issues to the placenta
• Fetal infections

HIE can occur during labor and delivery due to:

• Placenta abruption or rupture
• Prolonged labor
• Low blood pressure in the mother
• Abnormal fetal position
• Umbilical cord problems

And HIE can develop after delivery due to:

• Prematurity
• Serious infections or diseases
• Trauma to the head
• Low blood pressure in the baby
• Cardiac arrest

Because it can occur at any stage before, during, or after labor, doctors and physicians should be monitoring both the mother and baby for these potential issues to ensure they are being properly cared for and treated, even before or after labor and delivery.

Risk Factors for Perinatal Asphyxia

Doctors should always be monitoring the mother and infant in the months leading up to birth, and doctors should note and talk to patients if they have any of the following risks for perinatal asphyxia:

• Young mothers between 20-25 years old
• Multiple births such as twins or triplets
• Low birth weight
• Lack of prenatal care
• Abnormal position of the fetus (ie; breech)
• Preeclampsia or eclampsia
• History of prior birth asphyxia

Long Term Complications From Perinatal Asphyxia

Perinatal Asphyxia can cause a range of issues for the infant, ranging from mild to severe. There are also short and long term effects that may or may not occur depending on the severity and timing of the asphyxia.

Short term effects include:

• Build up of acid in the blood (acidosis)
• Hypertension (high blood pressure)
• Problems with blood clotting
• Respiratory distress
• Kidney problems

Long term effects will vary based on severity of the asphyxia. If the asphyxia lasts 5 minutes or longer, there is a significant risk of brain damage in the infant. This can lead to cognitive and behavioral changes that may be lifelong. These include:

• Hyperactivity
• Autism spectrum disorder
• Schizophrenia
• Psychotic disorders in adulthood
• Attention deficit
• Low IQ
• Cerebral Palsy
• Epilepsy or seizure disorder
• Vision or hearing impairments
• Intellectual disabilities

In some cases, it can be difficult to determine whether an infant has mild or severe asphyxia shortly after birth, and some of the complications may not be known until later in the child’s life. But doctors should make every attempt to properly and quickly diagnose perinatal asphyxia so as to reduce its severity.

Early Symptoms of Perinatal Asphyxia

Doctors need to be on the lookout for possible symptoms of HIE or asphyxia before, during, and after labor. Newborns with HIE may experience symptoms such as:

• Neonatal seizures
• Hypotonia (low muscle tone)
• Irregular breathing or heartbeat
• Difficulty feeding
• Listlessness or lethargy
• Blue or light gray skin
• Weak reflexes

Doctors should also be looking at the baby’s Apgar score at 1 and 5 minutes. Apgar stands for “Appearance, Pulse, Grimace, Activity, and Respiration”, and each category is scored on a scale of 0-2, with 2 being the highest. The combined score from all 5 categories is used to determine the final score.

A low Apgar score, in the range of 0-3 for the first five minutes, is an indicator of perinatal asphyxia, and may indicate the infant needs supplemental oxygen or intubation. Doctors may need to perform various tests such as an EEG or brain MRI to determine the severity of asphyxia.

Treatment for HIE

Infants may need breathing support, along with other treatment such as:

• Body cooling
• Blood pressure medication
• Kidney support
• Seizure medication
• IV nutrition

Body cooling, by bringing an infant’s temperature down to 91 degrees for around 72 hours can help prevent damage from the second stage of asphyxia in the baby’s brain. This second stage is called the “reperfusion injury” and is when normal blood returns to the brain. This can cause toxins to be released from the damaged brain cells, causing injury.

Body cooling treatment, or hypothermia, should only be used if the infant is born at 35 weeks or over, and must be started within 6 hours of birth. If the doctor fails to properly begin hypothermia treatment within the necessary time frame due to negligence, you may have standing to bring a legal case against them.