Articles Posted in Hypoxic Ischemic Encephalopathy

This case arose from the tragic set of events involving A.F., a baby born with severe respiratory problems who developed permanent brain damage. A.F.’s mother, Kayla Butts, brought this lawsuit claiming that A.F.’s brain damage was caused by the medical malpractice of Dr. Sarah Hardy. It was alleged that Dr. Hardy should have transferred Baby A.F. from the hospital where A.F. was born to a hospital with a neonatal intensive care unit that could have provided the care A.F. needed in the hours after her birth.

After a bench trial, the district court agreed and entered judgment in favor of Kayla Butts for over $7 million in damages. On appeal, the U.S. Court of Appeals considered whether she presented sufficient evidence to establish that Dr. Hardy violated the applicable standard of care.

Because the district court’s finding on that issue was clearly erroneous, the court of appeals reversed the district court’s order and vacated the judgment against Dr. Hardy.
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The use of fetoscopy was first developed in the 1990s. The process involves ultrasound-guided placement of a stethoscope – a small, fiber optic instrument – in the uterus to see the fetus and the placenta.

Fetoscopy as a surgical procedure can treat various fetal conditions including congenital diaphragmatic hernia and bladder outlet obstruction. Its most common use is the treatment of a rare condition, Twin-Twin Transfusion Syndrome (TTTS).

The condition of TTTS occurs when identical twins share a placenta with blood vessel connections that cause blood to flow unevenly between the two fetuses. According to the article, “Caught on Camera” by attorney Jeffrey B. Killino, one of the fetuses develops a small amniotic sac while the other sac becomes too large. Laser fetoscopy allows the laser to break up and collapse these blood vessel connections. Reportedly, if the condition is not treated, both of the fetuses can die. TTTS occurs in approximately 1 in 2,500 pregnancies. It is expected that there will be a rise in TTTS occurrences because of the increase in fertility-assisted pregnancies.
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More than a few studies have been conclusive showing that infants with hypoxic-ischemic encephalopathy have benefited when cooled to a temperature of 30 degrees Centigrade in a median time of 58 minutes. The cooling of newborns inspired oxygen requirements in a test involving six infants diagnosed with HIE.

Five of those infants required inotropic support during the cooling procedure. The cooling would be progressively reduced after 1-2 days. Inotropic support is the intensive care of newborns to stabilize circulation and to optimize oxygen supply.

Over the years, HIE has been recognized much more frequently. The onset of cases of HIE are caused by stroke, compressive forces or changes in oxygen circulating through the fetus before and immediately after delivery.
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In this lawsuit, the mother identified as Ms. Doe was admitted to a hospital to deliver her first child. Although the labor and delivery were prolonged, the treating obstetrician, Dr. Laura Fortner, advised Doe to keep pushing for another 30 minutes.

The obstetrician returned an hour later and used forceps and a vacuum extractor to deliver the baby who had become stuck in Doe’s birth canal. The baby’s Apgar scores were one at one minute and five at five minutes, requiring resuscitation.

The child, now age 16, has been diagnosed as having suffered hypoxic ischemic encephalopathy (HIE), which affects his cognitive, social and fine motor skills.
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Rebecca Kerrins, 38, was admitted to Palos Community Hospital in the Chicago suburb to deliver her second child. Following labor, she reported feeling a gush of blood. This was later diagnosed as a placental abruption.

Because of the placental abruption, her daughter lost up to 60% of her blood supply necessitating a blood transfusion at her birth.

Nurses paged the on-call neonatologist, Dr. Thomas Myers, every few minutes. Dr. Myers did not respond for almost an hour. He arrived at the hospital one hour and 12 minutes after the nurses first paged him.
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John Lipsey filed a lawsuit on behalf of his minor daughter, J.L., for injuries suffered by her at birth. The United States federal district court judge granted summary judgment in favor of the defendants who were sued for medical negligence under the Federal Tort Claims Act (FTCA).

On June 8, 2009, a criminal complaint was filed against Wenona White in federal court alleging charges of federal bank fraud. White was pregnant at the time with her tenth child. Lipsey was the father. White was scheduled to self-surrender to the U.S. Marshal on July 6, 2009, but she failed to appear in court and was not located until Sept. 10, 2009 when she was taken into custody.

Because White was 35 weeks pregnant by the time she was apprehended, the U.S. Marshals Service faced the challenge of finding a detention facility that was able to meet White’s late-pregnancy healthcare needs. The Marshals Service arranged for White to be housed at the Jerome Combs Detention Center (JCDC), a Kankakee County, Ill., facility that has an intergovernmental agreement with the Marshals Service. The JCDC had a full-time medical staff and a relationship with an obstetrics practice to handle the obstetric needs of its prison population.
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Elien Lorenzo received prenatal care from Dr. Nelson Alvarez-Reyes, M.D., an obstetrician employed by the federally funded clinic. During her prenatal care, she received several ultrasounds at this clinic. One of the ultrasound reports estimated a delivery date based on her last menstrual period. The calculation of the delivery date was more than three weeks earlier than the baby’s gestational age based on the measurements taken during the ultrasound test. Later test reports also showed the discrepancy of the projected delivery date.

Despite this information, Dr. Alvarez-Reyes induced labor more than four weeks before Lorenzo’s baby had reached full gestational age.

Before the delivery, the baby was shown to be under fetal distress. The baby was later diagnosed as having suffered hypoxic ischemic encephalopathy (HIE). The baby is now 4 years old and has developed mental delays, hearing loss and a seizure disorder.
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The mother, Doe, age 38, was 30 weeks into her pregnancy and considered in a high-risk pregnancy when she was admitted to the Roe Hospital due to preeclampsia. Several days later, during overnight hours, the fetal monitor showed severe late deceleration of her unborn baby, which continued for two hours. Despite orders for a STAT Caesarean section, the procedure was not performed until 90 minutes later.

Ms. Doe’s anesthesia wore off prematurely following the delivery. When the attending anesthesiologist attempted to intubate Doe, her abdomen filled with air. Doe subsequently coded and suffered profound brain damage. Ms. Doe lived in an institutional setting until she died almost six years later. She is survived by her husband and the baby who was delivered at that time and also suffered brain damage.

Ms. Doe’s sister, on behalf of her estate, her husband and her injured child, filed a lawsuit against the hospital and anesthesiologist claiming improper handling of fetal distress, late performance of the Cesarean section and negligent intubation.
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Vashti Daisley went to a hospital complaining of a lack of fetal movement during the late stages of her pregnancy. Dr. Donna Kasello, an obstetrician, performed a biophysical profile, which resulted in a score of two.

Dr. Kasello consulted a maternal-fetal medicine specialist, Dr. Kimberly Heller, and the patient later underwent a repeat biophysical profile, which resulted in a score of eight. Dr. Kasello discharged Daisley after 30 additional minutes of fetal monitoring.

The next day, Daisley’s treating obstetrician performed an emergency biophysical profile. The results were not reassuring, leading to the delivery of Vashti Daisley’s son by Cesarean section.
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Marla Dixon was admitted to a hospital in labor. Her obstetrician was Dr. Ata Atogho, a U.S. government employee. Dr. Atogho attended the delivery.

After the heartrate monitor of the fetus showed decelerations and poor variability, a nurse discontinued Pitocin and called Dr. Atogho who arrived sixteen minutes later. Dr. Atogho restarted the Pitocin. Dixon labored for another hour and a half.

Dr. Atogho then used a vacuum extractor to deliver Dixon’s baby son, who was born in a depressed condition with Apgar scores of one at one minute and four at five minutes.
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