Hypoxic ischaemic encephalopathy (HIE) birth injury claims

If your baby needed resuscitation or neonatal intensive care or was offered treatment with cooling after their birth, they may have suffered a type of brain injury called hypoxic ischaemic encephalopathy (HIE).

HIE brain injury occurs when the oxygen supply to the baby’s brain is interrupted, either partially over time or profoundly in the minutes before and/or after birth. It can be caused by pregnancy and birth complications or by delays and other medical or midwifery mistakes during labour, birth and the baby’s first few minutes of life. HIE birth injury can be mild, with few lasting effects. Moderate or severe HIE can cause long-term neurodevelopmental disability or cerebral palsy.

Birth injury can turn your family’s world upside down. You may be feeling confused and exhausted with worry about the future, or overwhelmed by the all the decisions and investigations which follow a diagnosis of hypoxic birth injury for a newborn baby.

On this page you will find the answers to many of the questions that families have about HIE birth injury: how it happens, what it means, and when you should seek help.

Our birth injury solicitors have helped countless families of children born with HIE brain injury to understand how their injury occurred and to claim the compensation and support that they need for their child. We can help you answer these questions with advice from trusted, independent medical experts, and secure the compensation and practical support that your baby deserves. If you would like to find out more about your baby’s HIE birth injury, and what that means for your baby and family, or you have been contacted by MNSI or NHS Resolution, contact us to talk, free and confidentially, to one of our experienced birth injury solicitors.  

What is HIE birth injury?

HIE birth injury is a serious condition which occurs when the normal blood supply to a baby’s brain is interrupted during pregnancy, labour, delivery or immediately after birth.

HIE is short for hypoxic ischaemic encephalopathy. (Each letter is pronounced separately as H.I.E). Hypoxia means shortage of oxygen. Ischaemia (or ischemia) means lack of blood supply. Encephalopathy refers to disease, damage or disorder to the brain. You may also hear healthcare staff or specialist lawyers using different words such as birth asphyxia, anoxia, perinatal asphyxia or neonatal encephalopathy when talking about your baby’s HIE birth injury. 

The blood circulation carries oxygen and glucose (sugar) to the brain. When the blood supply is cut off (ischaemia), this results in a lack of oxygen (hypoxia) and glucose (hypoglycaemia), and an increase in calcium, which damages the baby’s brain cells. During the mother’s labour and delivery, every minute of hypoxia significantly increases the child’s permanent neurodevelopmental disability.

HIE is not progressive but its effects may become more noticeable as the child develops, with different types of disability becoming more evident or problematic according to the child’s stage of development and needs at that time. This is important to understand, because for many babies with moderate or severe HIE the severe physical disability that would be expected from their hypoxic birth injury may be reduced by cooling. In their early years, these children may have no apparent remaining disability, but more subtle difficulties with communication, learning and autism/ADHD (which would otherwise have been masked by severe physical disability) may only become evident later in adolescence.

How do I know if my baby has HIE birth injury?

Your baby’s diagnosis of HIE will usually be based on their birth history, observations of their clinical signs and condition at birth, and the results of additional investigations and imaging.

When childbirth is complicated, delayed or traumatic, or where there are signs of fetal distress (or HIE) during labour, the midwife and/or obstetrician may anticipate that the baby will be born in poor condition and call for a paediatrician or neonatologist to be present at the birth to help with resuscitation. If the newborn baby is very unwell at birth, they may need to be transferred to a neonatal intensive care unit (NICU) for specialist neonatal care and cooling. 

Your baby’s neonatal team will look for any of these common signs of HIE birth injury immediately after your baby’s birth and in the first few days of life:

• low APGAR scores;
• abnormal skin colour (blue or pale);
• low heart rate;
• grunting or difficulties with breathing (respiration);
• fits (convulsions or seizures);
• problems with feeding;
• hypotonia (floppiness, reduced muscle tone);
• failure of other organs (kidneys, heart, lungs, liver);
• abnormal response to light (photophobia);
• abnormal level of consciousness (hyper-alert or excessively sleepy);
• altered brain electrical activity.

Your midwife will also carry out umbilical cord blood gas tests and regular observations of your baby’s condition, which can help with the diagnosis of hypoxic ischaemic encephalopathy (HIE).

Umbilical cord blood gas tests are performed by the midwife at birth to identify acidosis, which is a sign of HIE. The midwife takes a sample of blood from the vein and the arteries in the umbilical cord. During pregnancy, the umbilical vein takes food and oxygen from the mother (via the placenta) to the baby, and the two umbilical arteries take waste products including carbon dioxide and lactic acid back from the baby to the placenta. If the baby has been deprived of oxygen during the labour and birth, the blood sample from the umbilical artery will have an abnormally high level of acid.

Midwives also use a scoring system, known as the APGAR score, to assess the baby’s condition at one, five and ten minutes of life, based on a score of between zero and two each for the baby’s appearance, pulse, grimace, activity and respiration. The combined total score (out of ten) gives a general impression of the baby’s health. Low APGAR scores are often (but not always) seen in babies with HIE.

MRI scans of your newborn baby’s brain may be used by your baby’s medical team to confirm their diagnosis of HIE and to understand the timing and duration of the hypoxic event which caused the injury. This can help identify whether the HIE injury was the result of a profound, acute restriction of oxygen in the last few minutes of labour, a chronic partial lack of oxygen over a longer period of time or a combination of both. The precise timing of the hypoxia is often significant in establishing an HIE birth injury claim.

What kind of disability is caused by HIE birth injury?

Hypoxic ischaemic encephalopathy (HIE) is a serious condition, which can cause a range of neurological impairments and disabilities. These include:

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

In recent years, neonatal treatment with cooling has significantly reduced the physical disability suffered by many children with moderate or severe HIE, leaving them with no apparent ongoing harm from their injury. However, some of the more subtle effects of an HIE brain injury only become evident later, as the child grows and develops, so the full impact of their hypoxic birth injury can only properly be assessed over time.

Every child affected by HIE has their own, individual challenges and needs which evolve and change over time. We work with you, as parents, and our team of trusted experts to ensure that we understand the full impact of your child’s injury and their disability. This means that we can secure compensation settlements which we are confident will meet your child’s needs arising from their disability for the rest of their life.

What is cooling after HIE birth injury?

Cooling is a treatment that is given to babies born with moderate or severe HIE. Cooling slows the rate of damage to the injured baby’s brain and reduces their likelihood of suffering permanent physical disability. You may also hear cooling described as therapeutic hypothermia.

Cooling must be carefully managed with specialist neonatal intensive care and must begin within six hours of birth to be safe and effective. When properly managed, cooling with specialist neonatal intensive care is the best available treatment for babies after hypoxic brain injury.

You can learn more about cooling after HIE birth injury at Cooling for babies with HIE birth injuries.

Can medical negligence cause HIE birth injury?

When a newborn baby is diagnosed with HIE, shock and grief causes many parents (incorrectly) to blame themselves for the injury to their baby. In our experience, such guilt is usually totally unjustified. HIE has many causes and a significant proportion of HIE birth injuries are caused by medical negligence. 

After HIE birth injury, parents may be contacted and asked to agree to investigations by MNSI or by the NHS’ defence team at NHS Resolution. We strongly recommend that parents should seek their own legal advice from experienced hypoxic ischaemic encephalopathy (HIE) birth injury solicitors who specialise in helping patients, before responding to MNSI or NHS Resolution. You should understand that NHS Resolution’s role is to defend the NHS from medical negligence claims and by providing them with information, you may be prejudicing your child’s right to claim substantial compensation.

Read more about MNSI and NHS Resolution. 

HIE birth injury can be caused by mistakes by midwives, obstetricians (childbirth doctors), anaesthetists, paediatricians and neonatologists at any stage of the pregnancy, birth and neonatal (newborn) care. Some of the most common negligent mistakes which we find in HIE birth injury claims include:

• incorrect assessment of a pregnant mother’s risk;
• incorrect management of gestational diabetes, maternal hypertension or pre-eclampsia;
• fetal monitoring errors and incorrect management of fetal distress;
• failing to call a senior midwife or doctor (escalate) to review abnormalities or complications in labour;
• incorrect management of VBAC labour;
• failing to recognise signs of abruption, uterine rupture, or hyperstimulation in labour;
• incorrect use of oxytocin/Syntocinon in labour;
• delayed delivery by forceps, ventouse suction or caesarean section;
• failing to recognise obstructed labour;
• poor delivery technique (shoulder dystocia, impacted fetal head, breech birth, twins);
• failing to clear meconium from the baby’s airway;
• neonatal intubation, resuscitation, or ventilation errors;
• failing to keep the baby’s airway clear during neonatal skin-to-skin contact;
• delays and errors in neonatal cooling for HIE.

Why have MNSI contacted me after my baby’s HIE birth injury?

All NHS trusts which provide maternity services must report to the Maternity and Newborn Safety Investigations (MNSI) programme whenever a newborn baby is diagnosed with moderate or severe hypoxic ischaemic encephalopathy (HIE) or needs cooling.

Your healthcare team must tell you that they have reported your baby’s HIE birth injury to MNSI, and ask for your consent before sharing your details. MNSI must also ask for your consent before accessing your baby’s and their mother’s medical records in order to carry out an investigation of the maternity and neonatal care that your family received. If you consent to an MNSI investigation, they will share their findings with you, and with your hospital, and also with the NHS’ legal defence team at NHS Resolution.

We strongly recommend that you talk to one of our hypoxic ischaemic encephalopathy (HIE) birth injury lawyers for independent legal advice and support if you have been contacted by MNSI or NHS Resolution. Your call will be handled, free of charge and confidentially, by an experienced solicitor.

Read more about MNSI and NHS Resolution.

Why have NHS Resolution contacted me after my baby’s HIE birth injury?

NHS Resolution are the NHS’ legal defence team. Their purpose is to reduce the number of medical negligence claims that are made against the NHS and to minimise compensation payments to injured patients.

NHS Resolution contact families after their birth injury experiences are reported to them by NHS maternity services and MNSI. Their Early Notification (EN) scheme purports to advise (unrepresented and often vulnerable) families about whether their brain-injured child may be eligible for compensation, but actively uses the information they obtain directly from families to prepare their defence to any subsequent claim.

Parents should be aware that NHS Resolution deny liability and eligibility for compensation in the vast majority of cases involving unrepresented families of HIE-injured babies which come to them via the Early Notification (EN) scheme. In addition, evidence suggests that in the very rare cases where they make payments to families, these payments do not reflect the level of compensation that the child would receive if they were independently legally represented in a birth injury negligence claim. In our own extensive experience of handling claims against NHS Resolution, the vast majority of the high value compensation cases that we win for our clients began with NHS Resolution denying that NHS negligence 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 NHS Resolution have contacted you after the birth of your baby, we strongly recommend that you seek independent legal advice from a solicitor who specialises in helping families with birth injury claims.

What help can I get for my child with HIE birth injury disability?

A successful HIE birth injury claim will ensure that your child receives the care and therapeutic, educational and financial support that they need to manage their disability, for the rest of their life. Depending on the severity of their disability and the way it affects them physically, intellectually and behaviourally, their claim can also help support them in accessing special needs (SEN) or higher education, voluntary or paid work and, when the time comes, in living safely and independently in their own adapted home.

Each child’s compensation claim is tailored to meet their individual needs according to their injury, disability and individual circumstances. In most cases, as soon as we have investigated and established the NHS’ liability, we secure substantial interim (advance) payments which allow us to start meeting the child’s needs for additional help with care, therapies, specialist equipment, home adaptations and support with special educational needs (SEN), long before the case reaches its final settlement.

Read more about compensation and help with care and how we have helped previous clients and their families.