Traumatic birth-related brain damage is typically demonstrated by low Apgar scores, acidosis and the need for resuscitation to the newborn baby. In the developed world HIE affects 0.5 to 1 per 1000 live births.
HIE is a major problem worldwide as 10% to 60% of affected newborn children die and at least 25% of survivors have long-term neurodevelopmental injury. A newborn baby born in such poor health usually requires resuscitation at birth and supportive intensive care for a period of time. The overall objective of such treatment is to manage seizures, if present, and to restore newborn brain, vital organ function. Antiepileptic drugs (AEDs) are among the medications most commonly used for the treatment of seizures in a newborn baby with HIE.
The early induction of hypothermia in a newborn baby with HIE also improves survival and reduces the rate of disability. Again, the outcomes of HIE can be devastating and are likely to be permanent for the newborn baby, his or her family and society.
Complications caused by HIE in the newborn baby can vary from behavioural deficits to severe seizure, mental deficits and/or cerebral palsy. Newborn baby brain injury can also be caused by factors separate to and outside of HIE. An example being excessive force used during an instrumental delivery either by forceps or vacuum cup causing brain injury to the newborn baby. Cephalohematomas (accumulation of blood under the scalp) and subdural haematomas can be caused by a vacuum or forceps delivery. The failure to appropriately resuscitate the newborn baby and a delay in therapeutic cooling post-birth are further causes of newborn baby brain injury.
- Medical Negligence issues:
HIE to the newborn baby is primarily caused by the delay in delivery. The following factors in labour and at birth are indicative in causing or contributing to the diagnosis of newborn baby HIE:
- Failure to recognise risk factors present to mum and/or baby during labour;
- Failure to conduct continuous CTG (cardiotocograph) monitoring;
- Failure to interpret the CTG correctly;
- Misuse of syntocinon (used to enhance contractions) causing hypoxia in the baby;
- Inserting an umbilical catheter into the baby’s vein instead of the artery;
- Delayed interval between delivery of the baby’s head and the body;
- Failure to conduct delivery sooner and for example by emergency caesarean section;
The following failures in the neonatal period (a newborn baby in the first 28 days of life) can unfortunately also compound the diagnosis of HIE or indeed cause newborn baby brain injury by itself:
- Failure to adequately resuscitate the newborn baby;
- Delay in providing therapeutic cooling in the neonatal period;
- Failure to provide the appropriate medication treatment in the neonatal period.
- What is involved in newborn brain injury litigation?:
The Plaintiff (i.e. the person taking the case) must with the help of his or her legal and medical advisors prove both negligence and causation of newborn baby brain injury at the trial in the High Court. Negligence effectively means that the standard of care afforded by the particular defendant doctor fell below a reasonable medical standard to be expected of a doctor of like skill or specialisation. Once negligence is proved, it is then necessary to further prove causation of newborn baby brain injury. Meaning, the negligence must have caused or materially contributed to the newborn baby brain injury. To achieve this, all relevant mum and baby medical records need to be obtained and reviewed in detail. Thereafter, UK medical experts are instructed to address the sensitive issues of negligence and causation of newborn baby brain injury. The case is then advanced before the High Court and during that time the child is usually assessed by independent experts for both the Plaintiff and the Defendant. Such litigation is both challenging and complex. The standard of proof is high. The High Court must be satisfied that there is clear evidence of medical negligence causing newborn baby brain injury against the hospital or doctor in order to find or rule in favour of the Plaintiff. For example, an argument that is often advanced by the defendant hospital or doctor is that the newborn baby brain injury arose early on in the pregnancy and is unrelated to any negligence that may or may not be admitted during the course of labour and delivery.
- Case Study:
The Plaintiff’s mother had attended hospital on the day of birth suffering from a severe haemorrhage due to placenta previa. It was alleged on behalf of the Plaintiff that the hospital failed to monitor the baby adequately and to perform a caesarean section in a timely manner. The delay in delivery caused the Plaintiff to suffer periventricular leukomalaciawhich is the end stage of hypoxic ischemic brain injury due to asphyxial injury at birth. The Plaintiff had been subject to the effects of intra-partum hypoxia and ischemia (HIE). It was also claimed that the Plaintiff had been subject to excessive medication in the first few days of life. As a consequence, the Plaintiff has a neurological disability of asymmetrical spastic quadriplegia and developmental delay.
This complex case necessitated reviewing the Plaintiff’s medical records from 1984 to present and arranging numerous UK experts to report on the issues of negligence and furthermore whether the negligence identified was the cause of the Plaintiff’s brain injuries. Indeed, 16 independent medico legal experts were required for the Plaintiff's case. The defence argued that the medical care and treatment afforded to the Plaintiff and the Plaintiff's mother was consistent with the appropriate standard of care that would have been reasonably expected in 1984. Defendant expert obstetric evidence argued that there was no evidence in the medical records that the Plaintiff’s neurological injury was caused by a delay of three to four hours in the performance of a caesarean section at 32 weeks' gestation for placenta praevia. Consequently, there was no medical evidence to support a diagnosis of a neonatal encephalopathy. The Defendant further argued that the Plaintiff’s brain injury occurred prior to the mother attending hospital for labour and delivery.
The High Court trial ran for 12 days but did not conclude. The parties settled the proceedings for €3,500,000 that will help provide the necessary care and support the Plaintiff will require for the remainder of his life.
Indaville, Boherclogh, Cashel, Co. Tipperary, E25 V448