‘One of the most devastating complications that can result from medical mismanagement during labour and delivery is hypoxic ischaemic encephalopathy’ (K McCombe and D G Bogod).
Hypoxic Ischaemic Encephalopathy (HIE) is a term used to describe brain damage caused by a lack of oxygen (hypoxia) and / or a diminished amount of blood reaching a baby’s brain. HIE can occur during pregnancy, birth or shortly thereafter.
Some causes can include umbilical cord compression, placental abruption, shoulder dystocia (where a baby’s shoulders become stuck during labour), uterine rupture, infection and placental insufficiency. There are three categories of HIE – mild, moderate and severe. The longer the period of oxygen deprivation, the worse the damage can be.
HIE can arise from a delay in recognising fetal distress or a failure to deliver a baby quickly enough once this is recognised. In these circumstances there may be a claim for medical negligence.
Claims can involve a range of practitioners including midwives and obstetricians. Anaesthetists are also often involved if there are allegations that providing anaesthesia for a caesarean section was delayed.
While oxygen deprivation happens most commonly before or during birth, it is also possible for HIE to arise following a birth, for example due to a heart problem.
HIE can develop in a matter of minutes and have devastating lifelong impacts for the newborn baby and its family. Babies can develop other conditions associated with HIE including cerebral palsy, epilepsy, hearing and visual impairments, and respiratory and orthopaedic conditions.
Symptoms of hypoxia prior to or after birth can include an abnormal fetal heart pattern, problems with feeding, and a baby being born blue or floppy. Apgar scores – a test given to all newborns – can provide an indication of hypoxia. Other tests may be undertaken to assess any brain damage such as an MRI scan. It is important that a diagnosis is made quickly so that treatment can be considered and commenced. If there is a failure to diagnose HIE then, again, there may be a claim for clinical negligence.
Those with mild HIE generally recover well but where the condition is moderate or severe, there a greater risk of irreversible damage to the brain. Other organs can also be affected.
One of the most effective treatments for HIE is therapeutic hypothermia, also known as brain cooling. This must be given very shortly after birth (within six hours) to be effective. The therapy involves cooling a baby’s temperature to 33.5 degrees Celsius for 72 hours. Babies need to be monitored carefully during this process as complications can occur, such as with blood pressure control.
Early Notification Scheme
Where a baby is diagnosed with HIE as a result of an incident surrounding their birth, then there is likely to be an investigation by the NHS as part of the Early Notification Scheme (ENS). More information about this is available on our ENS page and we offer a free consultation to all families going through this process.
Legal claims
If injuries from HIE were suffered as a result of medical negligence then there may be a claim to recover compensation for the needs of the baby going forward, including care, adaptations to accommodation, specialist equipment, therapies and education. Our medical negligence team at Kingsley Napley are specialists in claims involving HIE and provides a sensitive and supportive service as well as the highest level of legal advice. You can read about some of the Birth Injury cases we have acted in on our case studies page.
Where a baby has died, a solicitor may be able to assist with representation at an inquest.
Please contact our team on 020 7814 1200 for a free no obligation discussion if you have any concerns about medical treatment related to a birth.
Support
Peeps HIE is a charity providing support to those affected by HIE. More information can be found on their website.
Further Information
If you have any questions or concerns about the issues raised in this blog, please contact any member of the Medical Negligence and Personal Injury team.
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