What You Need to Know
- HIE is associated with reduced oxygen and blood flow to the brain around the time of birth.
- An HIE diagnosis is not itself a finding of fault — the records show when oxygen was lost and how the team responded.
- Fetal-monitor strips, delivery timing, cord gases, neonatal records, and imaging may help determine what happened.
- Delays in responding to fetal distress may warrant investigation.
What HIE Means
Hypoxic-ischemic encephalopathy (HIE) is a type of neonatal brain injury caused by a combination of hypoxia (insufficient oxygen) and ischemia (insufficient blood flow) to the brain around the time of birth. In general, the longer and more severe the deprivation, the greater the risk of lasting harm — from subtle cognitive difficulties to severe disability or death.
HIE is described in the medical literature as a major cause of neonatal death and neurological disability in full-term newborns. Long-term effects reported in survivors include cerebral palsy, developmental delays, cognitive impairment, and seizures. Whether a particular child's HIE could have been prevented is a question the medical records — not the diagnosis — can answer.
How HIE Is Evaluated and Graded
In the first hours after birth, physicians grade HIE using the Sarnat staging system based on neurological examination:
Grade I — Mild
Irritability, feeding difficulty, hyperalertness lasting under 24 hours. Prognosis is generally favorable, though subtle issues can emerge at school age.
Grade II — Moderate
Lethargy, suppressed reflexes, and seizures within the first 24 hours. Cooling therapy is the standard treatment; meaningful risk of lasting disability.
Grade III — Severe
Profound unresponsiveness and multi-organ dysfunction, with high mortality and a high risk of significant permanent disability.
Signs families often see
At birth and in the NICU
A low Apgar score and resuscitation at delivery; seizures in the first hours or days; unusually floppy or stiff muscle tone; difficulty breathing or feeding; reduced consciousness; signs of organ dysfunction.
As the child grows
Missed motor and developmental milestones; impaired coordination; a later cerebral palsy diagnosis; seizure disorders; cognitive, speech, or learning difficulties.
Cooling Treatment: Why Timing Is Everything
For a newborn with moderate to severe HIE, therapeutic hypothermia — carefully cooling the baby's body for about 72 hours — is the established treatment for eligible newborns, shown in major clinical trials to reduce death and lasting disability when begun early — generally within about six hours of birth.
That narrow window is why the treatment timeline — who recognized what, and when — is often a central question when these cases are investigated. When staff fail to recognize HIE, delay the assessment, or miss the cooling window, the opportunity for this treatment is lost. What effect that had on a particular child's outcome is a question only qualified experts can answer from the records.
Possible Long-Term Effects
The long-term outlook depends heavily on the severity of the initial injury and how quickly it was treated. Many children with mild HIE recover well. Moderate and severe HIE carry meaningful risk of cerebral palsy, epilepsy, and intellectual disability — and children with moderate or severe HIE may need multidisciplinary care over many years, in some cases decades, much of it the same care required for cerebral palsy. Because of that association, the long-term needs — and the way a claim is valued — closely track the severity of any resulting disability.
Circumstances That May Warrant an HIE Investigation
An HIE diagnosis alone cannot tell you whether the injury could have been prevented. That answer lives in the medical records: what was happening during labor and delivery, and how the care team responded. Attorneys and medical experts look closely at circumstances like these:
Fetal distress that was missed or unaddressed
Electronic fetal monitoring is used to assess fetal well-being during labor and to identify heart-rate patterns that may signal fetal compromise. Nurses and physicians must recognize concerning fetal-heart-rate patterns, perform clinically appropriate resuscitative measures, reassess medications such as oxytocin, escalate the concern, and determine whether expedited delivery is necessary.
Fetal heart monitoring failures →ACOG: Fetal Heart Rate Monitoring During Labor ↗
A delayed emergency C-section
When an emergency cesarean is called for, minutes matter. The widely cited 30-minute decision-to-incision interval is a preparedness benchmark rather than an absolute rule, but unexplained delays — staffing problems, an unprepared OR, an unreachable physician — can close the window for a protective intervention.
Umbilical cord accidents
Cord prolapse and cord compression are medical events that can restrict the baby's oxygen supply. In an investigation, the questions are separate ones: how quickly the problem was recognized, and how the care team responded once it was.
Unmanaged placental abruption
Abruption — premature separation of the placenta — can acutely restrict the baby's oxygen supply. An investigation examines when the abruption was suspected, when it was diagnosed, and how quickly delivery followed.
Oxytocin (Pitocin) mismanagement
In excessive doses, or continued despite non-reassuring heart-rate patterns, oxytocin can cause uterine hyperstimulation — contractions too frequent to allow adequate fetal oxygenation between them.
A missed cooling window
A failure to evaluate a newborn against cooling criteria, or to arrange transfer for cooling therapy without unreasonable delay, may worsen the injury and can extend responsibility beyond the labor and delivery team.
Signs families often notice first
- An abnormal fetal heart tracing during labor
- An emergency C-section that came later than staff first indicated
- Low Apgar scores or resuscitation in the delivery room
- An NICU admission with an HIE diagnosis or cooling therapy
- MRI findings consistent with hypoxic-ischemic injury
- Inconsistent or incomplete explanations from hospital staff
None of these proves negligence on its own — but any of them makes a records review worth pursuing. The fetal monitor strip, nursing notes, and delivery records capture the timeline, and preserving them early is critical.
What Evidence Thomas & Wan Reviews
Whether the care met accepted standards — and whether any departure caused the injury — is answered by the medical record, not by the diagnosis alone. The review typically includes:
- Fetal heart monitor strips
- Labor and delivery records
- Nursing notes
- Physician orders
- Operative reports
- Cord-blood gas results
- Apgar scores
- Neonatal and NICU records
- MRI and other brain imaging
- EEG and neurological testing
- Cooling therapy records
- The timeline of escalation and delivery
A Thomas & Wan Case Involving HIE
In one resolved Thomas & Wan case, the evidence showed prolonged decelerations, minimal variability, and other clear signs of fetal distress that were repeatedly missed or ignored, delaying the emergency delivery that could have prevented permanent brain injury. As a result of the delayed C-section, the child suffered severe hypoxic-ischemic encephalopathy (HIE), cerebral palsy, profound neurological injury, and lifelong disability.
Through settlement, Thomas & Wan secured compensation for lifelong medical care, therapy, nursing support, adaptive equipment, and the child's future needs.
Read the full result: Failure to Recognize Fetal Distress →
Past results do not guarantee a similar outcome. Every case depends on its own medical evidence and legal circumstances.
How Thomas & Wan Investigates an HIE Case
Collect the records
The complete labor, delivery, and neonatal records — including the fetal monitor strips, nursing notes, cord gases, and imaging.
Reconstruct the timeline
Minute by minute: what the tracings showed, who was told, when decisions were made, and when the baby was delivered and assessed.
Review with qualified experts
Obstetricians, neonatologists, and pediatric neurologists evaluate whether the response met the standard of care, measured against professional guidance from bodies such as ACOG, the AAP, and AWHONN.
Evaluate causation, damages, and options
Whether the evidence connects the care to the injury, what the child's future needs are, and what legal paths the family has.
To prevail, a Texas medical malpractice claim must ultimately prove four things: a duty of care, a departure from the standard of care, causation connecting that departure to the child's injury, and damages. Each element is established through the records and qualified expert testimony — which is why the investigation above comes first, and why no conclusion is reached before it is complete.
Texas Legal Considerations
- Texas Civil Practice & Remedies Code Chapter 74 (the Texas Medical Liability Act) governs all claims, imposing strict procedural requirements on plaintiffs.
- Texas law requires an expert report from a physician qualified in the relevant specialty early in the case, on a strict statutory timeline — failing to meet it can end the claim.
- Filing deadlines apply, and for cases involving a minor child they can be complicated and fact-dependent — families should speak with a qualified attorney promptly so the applicable deadline can be evaluated.
- Texas law caps non-economic damages; economic damages — medical costs, therapy, future care, lost earning capacity — are not capped. How the caps apply to a particular case is a question for an attorney.
- Texas law requires pre-suit notice to healthcare providers before filing.
Background on how deadlines work is in our guide to Texas medical-malpractice filing deadlines. Early investigation preserves evidence and legal options.
Long-Term Care and Potential Compensation
When HIE causes lasting disability, the cost of care can span a lifetime — and most of it falls outside what insurance covers. No national statistic captures what your child will actually need: a properly built claim quantifies those needs individually through an expert life-care plan, and value is driven mainly by that projected lifetime cost and the strength of the evidence connecting a breach of the standard of care to the injury.
What compensation can cover
- Lifetime medical care, hospitalizations, and physician oversight
- Physical, occupational, and speech therapy for life
- Assistive equipment, home and vehicle modifications
- Skilled attendant care, often around the clock in severe cases
- Special education and lost future earning capacity
- Pain, suffering, and loss of enjoyment of life
What drives a settlement's value
- The severity of the child's disability and cognitive involvement
- The projected lifetime cost of care, therapy, and equipment
- The strength of the evidence connecting a departure from the standard of care to the injury
- Life expectancy and the present value of decades of future care
- Applicable Texas damage rules, including the cap on non-economic damages (economic damages are not capped)
For a detailed breakdown of how these cases are valued, read How Much Is a Cerebral Palsy Lawsuit Worth? — and see representative outcomes on our case results page. Past results do not guarantee a particular outcome.
Why Thomas & Wan Handles HIE Cases
Thomas & Wan, LLP focuses exclusively on medical malpractice and birth injury litigation. Our attorneys have extensive experience investigating HIE cases — analyzing fetal monitor strips, reviewing NICU records, and working with qualified obstetricians, neonatologists, and pediatric neurologists. We do not take cases we do not believe in, and we prepare every case as though it will be tried.
Our firm is women-owned, with more than 60 years of combined experience representing families throughout Houston and the surrounding region — The Woodlands, Katy, Sugar Land, Pearland, Pasadena, and across Harris, Fort Bend, Montgomery, and Brazoria counties.
Google Reviews
General client reviews of the firm, posted publicly on Google.
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Frequently Asked Questions
Does HIE automatically mean medical malpractice?
No. HIE can occur even when the medical care met the standard of care, and current American Academy of Pediatrics guidance notes that treatment with therapeutic hypothermia does not, by itself, establish hypoxia-ischemia as the cause of a newborn's encephalopathy. What an HIE diagnosis does justify is a careful review of the records to determine when the injury likely occurred and whether the care team's response met the standard of care.
What records are reviewed in an HIE case?
The fetal heart monitor strips, labor and delivery records, nursing notes, physician orders, cord-blood gas results, Apgar scores, NICU records, cooling-therapy records, brain imaging such as MRI, and neurological testing such as EEG. Together these records help establish when oxygen deprivation likely began and how the care team responded. Qualified medical experts review them before any conclusion is reached.
When is cooling treatment considered?
Therapeutic hypothermia (whole-body cooling) is the standard neuroprotective treatment for moderate to severe HIE in eligible newborns. In the major clinical trials it involved cooling for about 72 hours, generally beginning within about six hours of birth — which is why prompt recognition matters. Whether a delay in evaluating a newborn for cooling breached the standard of care is a fact-specific question for expert review.
Can delayed delivery contribute to HIE?
It can. When fetal distress goes unrecognized or an emergency delivery is delayed without explanation, the window for a protective intervention can close while oxygen deprivation continues. A delay is not automatically negligence — what counts as a timely response depends on the clinical circumstances — but the timeline documented in the monitoring strips and delivery records is often central to an HIE investigation.
How long do families have to investigate in Texas?
Filing deadlines apply to Texas medical-malpractice claims, and for birth-injury cases involving a minor child they can be complicated and fact-dependent — no family should assume extra time applies to their situation. Texas law also imposes strict procedural requirements, so the safest step is to speak with a qualified attorney promptly, while the evidence is still fresh.
What does an HIE case review cost?
Nothing. Thomas & Wan, LLP handles HIE birth injury cases on a contingency-fee basis: the initial case evaluation — including review of medical records, fetal monitor strips, and imaging — is free and confidential, and attorney fees are paid only as a percentage of a settlement or verdict, only if we recover compensation for your family.
Talk to a Houston HIE Birth Injury Attorney
If your child was diagnosed with hypoxic-ischemic encephalopathy and you have questions about whether medical negligence played a role, Thomas & Wan, LLP offers free, confidential case evaluations. We review the medical records and fetal monitor strips, consult with expert physicians, and provide an honest assessment — at no charge and with no obligation. Our firm works on a contingency fee basis: you pay nothing unless we recover compensation for your family.
Call (713) 529-1177Have Your Child's HIE Case Reviewed
Free & confidential case review. No obligation. No fee unless we recover.