What is HIE? Understanding the Condition and Its Effects on Newborns

For expecting parents, every decision made during pregnancy and childbirth is centred around the safety and well-being of their baby. However, complications during or after delivery can sometimes result in unexpected and life-altering outcomes. One such condition is Hypoxic-Ischaemic Encephalopathy (HIE), a neonatal brain injury caused by oxygen deprivation.

Recent reviews surrounding maternity services at Portiuncula University Hospital (PUH) in Ireland have brought this condition to the forefront, raising questions about the quality of care provided and the associated risks for mothers and their newborns. This blog will explain what HIE is, its causes and symptoms, and offer insights into addressing cases of medical negligence.

What Is Hypoxic-Ischaemic Encephalopathy (HIE)?

HIE occurs when a baby’s brain doesn’t receive enough oxygen or blood flow during pregnancy, delivery, or shortly after birth. This lack of oxygenated blood can cause lasting damage to their developing brain, potentially leading to neurological and developmental issues.

Key Facts About HIE:

  • Prevalence: HIE affects between 1 and 3 per 1,000 full-term births worldwide and is more common in premature babies.
  • Severity: The condition ranges from mild to severe, and the extent of long-term complications depends on how quickly treatment is provided. Mild cases may resolve without significant impact, while severe cases can result in cerebral palsy, epilepsy, learning disabilities, or motor disorders.
  • Treatment Options: One major intervention is therapeutic hypothermia, often known as neonatal cooling. This treatment involves lowering the baby’s body temperature to reduce brain damage, but it must be administered within six hours of birth for maximum effectiveness.

Symptoms and Causes of HIE:

Symptoms of HIE in Newborns:

The presentation of HIE varies depending on the severity of the oxygen deprivation. Symptoms may include:

  • Difficulty breathing or low oxygen levels.
  • Unusual alertness or lethargy.
  • Poor feeding or sucking reflex.
  • Seizures or abnormal movements.
  • Weak muscle tone or reflexes.
  • Slow heart rate.

Common Causes:

HIE often results from complications during pregnancy, labour, or the neonatal period. Risk factors include:

  • Labour and Delivery Issues:
  • Use of forceps or vacuum extraction during delivery.
  • Umbilical cord complications, such as compression or prolapse.
  • Prolonged labour or delayed delivery.
  • Maternal Health Factors:
  • Preeclampsia or high blood pressure during pregnancy.
  • Uterine rupture or problems with the placenta.
  • Neonatal Factors:
  • Premature birth or underdeveloped lungs.
  • Foetal heart abnormalities or trauma during delivery.

For parents, understanding these risk factors can help ensure proactive communication with healthcare providers and better monitoring during pregnancy and childbirth.

Why Is HIE in the Spotlight at Portiuncula Hospital?

Context of the Current Reviews

The Health Service Executive (HSE) of Ireland has launched external reviews into maternity care at Portiuncula University Hospital following the diagnosis of HIE in seven newborns across 2023 and 2024. Six of these babies required therapeutic hypothermia. Disturbingly, this rate is significantly higher than national and international averages. Two stillbirths at PUH during this period are also under review.

These developments have led to growing concerns about the hospital’s ability to ensure safe and high-quality maternity care. Families affected by these cases have voiced their distress, prompting action to investigate potential issues, including staff shortages, medical errors, and miscommunication during labour and delivery.

Historical Concerns at PUH

This is not the first time Portiuncula’s maternity services have come under scrutiny. A report from 2018 detailed systemic failures in care standards between 2008 and 2014, including inadequate training and staffing, poor communication, and failures to disclose incidents to families. These past issues make the recurrence of such concerns particularly troubling.

Addressing Medical Negligence in Birth Injuries:

Birth injuries, including HIE, can sometimes be the result of medical negligence. This occurs when healthcare professionals fail to meet the expected standard of care, resulting in harm to the baby or mother. Examples of medical errors linked to HIE include:

  • Failure to monitor foetal distress during labour.
  • Delayed decision-making, such as postponing emergency C-sections.
  • Improper use of labour-inducing drugs or delivery tools.

Steps for Families Affected:

If your child has been diagnosed with HIE or you suspect negligence, consider these steps to understand your options:

  1. Request Medical Records:

Request a complete history of medical records related to the pregnancy, labour, and delivery to identify potential lapses in care.

  1. Consult Medical Experts:

Seek opinions from independent medical professionals to evaluate whether the treatment provided adhered to established standards.

  1. Legal Guidance:

Contact solicitors who specialise in birth injury cases. If negligence is confirmed, families may pursue claims to cover the financial and emotional costs of their child’s care.

What Does the Future Hold for PUH?

The HSE has assured patients that reviews will be completed by February 2025, with personalised feedback provided to affected families. Additionally, expectant mothers set to give birth at PUH have been offered the option to transfer their care to other facilities.

While the hospital has implemented corrective measures, including the appointment of an external consultant obstetrician and a new management team, rebuilding trust will be a gradual process. Advocacy groups and healthcare professionals are emphasising the need for regulatory reforms to ensure continuous improvement in maternity care services.

Moving Forward With Compassion and Support

For families affected by Hypoxic-Ischaemic Encephalopathy, the road ahead may feel daunting. HIE has long-term implications, but with timely intervention, tailored medical care, and legal support, parents can secure the resources needed to enhance their child’s quality of life.

At HOMS Assist, we stand ready to support families facing birth-related injuries. Whether you need guidance on your legal rights, referrals to trusted medical professionals, or simply want someone to advocate for your family’s future, we are here to listen and help.

Together, we can push for accountability and safer maternity care systems that minimise the risks of conditions like HIE.

Your Voice Matters

If you or a loved one has been affected, don’t hesitate to reach out for a consultation. With expert solicitors across Dublin, Limerick, and Cork, HOMS Assist is dedicated to providing compassionate and professional guidance to families navigating birth-related trauma.

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