Hypoxic-ischemic encephalopathy is a brain injury caused by lack of oxygen at birth. The first 6 hours of your baby's life are a clinical window where cooling therapy can change the outcome. When that window is missed, families deserve answers. Our M.D./J.D. medical-legal team reads the cord gases, MRI, and Sarnat staging like physicians — and finds the moments that mattered.
Hypoxic-ischemic encephalopathy (HIE) is a brain injury caused when a baby does not receive enough oxygen (hypoxia) and blood flow (ischemia) at or near the time of birth. HIE is the most common identifiable cause of birth-related cerebral palsy, seizure disorders, and neonatal death. According to the National Institutes of Health, HIE affects approximately 1.5 to 2.5 of every 1,000 full-term births in developed countries.
Doctors classify HIE by severity using the Sarnat staging system: Stage 1 (mild) typically resolves with little or no permanent injury; Stage 2 (moderate) commonly results in long-term neurological deficits; Stage 3 (severe) carries a high risk of death or profound disability. Cord blood gas results — particularly an arterial pH below 7.0 or a base deficit greater than 12 — help confirm acute intrapartum hypoxia. Neonatal MRI later shows the pattern and timing of the injury.
Not every HIE case is the result of malpractice. But many are. When a labor and delivery team fails to recognize fetal distress, delays an emergency C-section, or does not initiate therapeutic hypothermia within the 6-hour window, the result can be the difference between a healthy child and one with lifelong disability. Those are the cases we take.
The most common preventable causes of hypoxic-ischemic brain injury we see in litigation.
Recurrent late decelerations, prolonged bradycardia, and loss of variability are the hallmark warning signs of an oxygen-deprived baby. When nurses misread the strip or fail to escalate, brain injury follows.
When a Category III tracing demands immediate delivery, the recognized standard is decision-to-incision within 30 minutes. Every additional minute the baby remains in a hostile uterine environment deepens the brain injury.
A prolapsed or tightly compressed cord cuts off oxygen quickly. The clinical response — manual elevation of the presenting part and immediate C-section — is taught at every L&D unit. Failure to execute it is malpractice.
When the placenta separates from the uterine wall before delivery, the baby's oxygen supply is cut off. Hallmark signs — sudden vaginal bleeding, severe abdominal pain, hypertonic contractions, and abnormal fetal heart rate — demand urgent delivery.
Most common in women attempting vaginal birth after C-section (VBAC). When the uterus tears, fetal oxygenation drops within minutes. Counseling, monitoring, and rapid surgical response are required.
Cooling therapy must begin within 6 hours of birth to be effective. Failure to identify HIE in time, failure to transfer to a cooling-capable NICU, or simply not initiating the cooling protocol is one of the most preventable harms in modern obstetric care.
A baby born depressed needs immediate, correct resuscitation. Failure to follow the Neonatal Resuscitation Program (NRP) algorithm — including timely intubation and ventilation — can extend the hypoxic insult.
Excessive Pitocin causes tachysystole — too many contractions, too close together — which compresses placental blood flow and starves the baby of oxygen. Standard protocols call for monitoring and immediate dose reduction.
When a fetal monitor fails to record or fails to alert clinicians to a deteriorating tracing, the harm can be devastating. These failures may give rise to product liability claims layered on top of medical malpractice.
HIE cases turn on timing — minute by minute. Here's how our team reconstructs what happened.
Fetal heart rate strip, contraction pattern, nursing notes, anesthesia record, cord blood gases, Apgar scores, resuscitation log, head ultrasound, brain MRI, Sarnat staging. Herb reads them the way a physician reads them and identifies every deviation from the obstetric and neonatal standard of care.
Maternal-fetal medicine for the intrapartum standard of care. Neonatology for the resuscitation and cooling decisions. Pediatric neuroradiology to interpret the MRI and pinpoint injury timing. Pediatric neurology for prognosis and life care planning.
The OB. The hospitalist. The L&D nurses. The neonatologist. The transferring and receiving hospitals when cooling was delayed by transfer. The device manufacturer if a fetal monitor or infusion pump failed. Every defendant brings additional insurance coverage to the case.
Alex Alvarez is a Board Certified Civil Trial Lawyer (NBTA) — a credential held by less than 1% of attorneys. Hospital systems and their insurers settle differently when they know the firm across the table is actually prepared to try the case.
Because moderate-to-severe HIE often produces lifelong neurological injury, HIE verdicts and settlements rank among the largest in birth injury law. A child left with permanent disability may need:
On top of economic damages, families recover non-economic damages for pain and suffering, loss of enjoyment of life, the parents' emotional distress, and the loss of the normal parent-child relationship. When the negligence is egregious, punitive damages may also be available.
A certified life care planner builds a detailed projection of every cost your child will face for their entire lifetime, and an economist reduces those figures to present value. Those projections are the financial backbone of every successful HIE recovery.
Not by itself. An HIE diagnosis tells us the baby was deprived of oxygen, but the legal question is whether the medical team did everything they should have done to prevent or limit the injury. We look at whether the fetal heart rate tracing was correctly interpreted, whether the decision to deliver was timely, whether resuscitation followed the NRP algorithm, and whether cooling therapy was offered within the 6-hour window. Herb Borroto, M.D., J.D., reads the chart and tells you honestly what he sees.
Often, yes. The fact that cooling was eventually started does not erase a delayed C-section or a missed Category III tracing. Cooling reduces but does not eliminate the long-term injury caused by an extended hypoxic event. Many of our HIE cases involve babies who were ultimately cooled but were deprived of oxygen for far too long before delivery.
Cooling slows the cascade of brain cell death that follows oxygen deprivation. The baby's core temperature is lowered to about 33.5°C for 72 hours, then slowly rewarmed. Multiple large randomized trials have shown that babies cooled within 6 hours of birth have significantly better neurodevelopmental outcomes than those who are not. Missing the cooling window is a recognized standard-of-care issue in modern neonatology.
Statutes of limitations vary by state, and most states extend the filing window for injuries to minors. Some states toll the clock until the child reaches a certain age. Because the rules differ everywhere, the most important step is to call us as soon as possible so we can evaluate your case under the deadline that applies where the injury occurred.
Nothing upfront. The Alvarez Law Firm handles every HIE case on a contingency fee basis. No Fees Unless We Recover Money for You. The case review itself is free, confidential, and comes with no obligation.
Herb Borroto, M.D., J.D., will personally review your labor, delivery, and NICU records. No cost. No obligation. Just an honest read from a doctor and a trial lawyer on whether your baby's HIE was preventable.
