Your Newborn Was Diagnosed With HIE: A Guide for Idaho Families

If a doctor has told you that your baby has hypoxic-ischemic encephalopathy, or HIE, you are probably reading this from a chair beside an incubator, on very little sleep, trying to make sense of words you had never heard a week ago. We wrote this guide for you. It explains in plain language what HIE is, how it is diagnosed and treated, what the next weeks may hold, and what the long-term picture can look like. It also covers things families are rarely told early: how to think about whether an injury could have been prevented, which records can disappear if no one asks for them, and how Idaho’s unusually short legal deadlines work. Nothing here replaces your baby’s medical team. But parents who understand the vocabulary ask better questions, and better questions lead to better care.

What HIE Is

HIE is a brain injury caused by a shortage of oxygen and blood flow to the baby’s brain during labor, delivery, or the first minutes of life. The name describes each part of that:

• Hypoxic means too little oxygen reached the brain.
• Ischemic means too little blood flow reached the brain.
• Encephalopathy means the brain is not working normally. In a newborn, that can look like a baby who is unusually floppy or stiff, hard to wake, not feeding, breathing irregularly, or having seizures.

HIE is one of the most serious conditions a full-term baby can have. In the United States and other high-income countries it affects roughly 1 to 3 of every 1,000 babies born at term. Doctors grade it as mild, moderate, or severe, but even so-called “mild” HIE is very serious and can carry life-long consequences for your child.  Even otherwise healthy premature newborns can suffer HIE during labor and delivery, and it has nothing to do with the fact that baby was born early, but rather often is due to other factors including how the labor and delivery was handled in terms of standard of care.

Two more things every parent should know:

• It is not something you caused. Nothing a mother ate, did, or felt during an otherwise normal pregnancy causes HIE.
• It is one of the leading causes of cerebral palsy. Cerebral palsy is a diagnosis made later, usually within the first two years, once the brain injury’s effect on movement becomes clear. Children with any degree of HIE are at risk of cerebral palsy, epilepsy, and developmental disability, which is why follow-up and early intervention matter so much.

How Doctors Diagnose HIE

Doctors diagnose HIE from several pieces of evidence gathered in the first hours and days of life. Together they establish both that the brain was injured and that the cause was a shortage of oxygen and blood flow during labor and delivery. Here is what each one means.

• Apgar scores. A quick 0-to-10 assessment at 1 and 5 minutes after birth, and at 10 minutes if the baby is struggling. A low one-minute Apgar can be indicative of HIE depending on the overall circumstances and sequence of events.
• Umbilical cord blood gases. A blood sample taken from the cord right after delivery. It shows how acidic the baby’s systemic blood had become, which can sometimes, but not always, reflect how severely the baby was deprived of oxygen before delivery. A cord gas should be drawn whenever a baby is born in distress; if the hospital did not draw one, that is worth noting. A cord gas with a high PCO2 respiratory component can indicate severe cord compression or occlusion consistent with a sentinel event that deprived the fetus of oxygenated blood flow and can reflect the status of the fetus just before a bradycardic event, so look to see how the lab characterized the findings in terms of critical or low. Note that so-called “base excess” is a poor proxy for fetal status and should not be exclusively relied upon.
• The need for resuscitation. Breathing support, chest compressions, or medication in the delivery room, and how long it took for the baby to breathe on his or her own. Any amount of resuscitation can be consistent with HIE from labor and delivery, no matter how long or brief the resuscitation may have been.
• The neurologic exam and Sarnat stage. Doctors grade HIE as mild, moderate, or severe, sometimes using a system called Sarnat staging. It scores alertness, muscle tone, posture, reflexes, breathing, pupils, and seizures. The stage drives treatment, especially the decision whether to cool. Note, however, that even so-called “mild” HIE can be a devastating diagnosis leading to cerebral palsy and life long disability.
• EEG or aEEG. Brain-wave monitoring detects seizures, many of which have no outward signs in newborns, and shows how disturbed the brain’s electrical activity is. Seizures in the first several days can be consistent with HIE from labor and delivery, and seizures are one of the ways that the injured newborn brain is showing itself.
• Brain MRI. Usually done within the first one to two weeks. The MRI confirms the injury, shows which parts of the brain were affected and how extensively, and is the best early guide to what to expect. An early MRI done on or around day-of-life 4 is the gold-standard for a diagnosis of HIE from labor and delivery, and a finding of injured brain tissue (shown by bright diffusion restriction) is very serious.

Ask for a copy of each of these as it becomes available. The MRI in particular should be requested as the actual images on a disc or secure download, not just the written report.

Therapeutic Hypothermia: The One Treatment Proven to Change Outcomes

Therapeutic hypothermia, which NICU teams simply call “cooling,” is the only treatment for term newborns proven to improve outcomes in moderate-to-severe HIE. The baby’s body temperature is lowered to about 33.5°C (92.3°F) with a cooling blanket or cap, held there for 72 hours, and then raised slowly over several hours. Cooling slows the second wave of brain-cell death that follows the initial oxygen shortage, which is why it only works if it starts early.

What the evidence shows. In the large randomized trials, cooling lowered the combined risk of death or major disability. A 2013 Cochrane review that pooled 11 trials and 1,505 infants found cooling cut that combined risk by about a quarter in relative terms, and by roughly 15 percentage points in absolute terms. Put another way, for every seven babies with moderate-to-severe HIE who are cooled, one is spared death or major disability who otherwise would not have been. Cooling also reduced death on its own and reduced disability among survivors. The American Academy of Pediatrics has endorsed it as the standard of care since 2014.

Who qualifies. Cooling is offered to babies born at or near term (generally 35 weeks or more) who show signs of oxygen deprivation during labor and delivery, such as a low cord pH, low Apgar scores, or a need for resuscitation, and who show moderate or severe encephalopathy on exam.

Timing. Cooling should begin within six hours of birth, and the sooner it starts, the more of the brain it protects. A delay in recognizing the baby’s condition, in calling the receiving NICU, or in arranging transport can cost a child that protection.

If your baby was born at a hospital that cannot cool. Many Idaho hospitals do not have cooling equipment or a NICU equipped to manage it. That does not excuse them from the six-hour window. A delivering hospital is expected to recognize a baby in trouble, call the receiving NICU, begin “passive cooling” (turning off the warmers) on that NICU’s instructions, and get the baby to a higher-level NICU in Boise or Idaho Falls, or out of state to Spokane or Salt Lake City, in time to cool. The six-hour clock starts at birth, not at arrival.

Mild HIE. The landmark trials studied moderate and severe HIE, but newer research shows that mild HIE is not harmless, and a growing number of hospitals now cool babies with mild HIE as well. If your baby was diagnosed with mild HIE and was not cooled, ask what that decision was based on.

What the First Weeks Often Look Like

The first week is usually the hardest, and much of it is spent waiting. Here is what families commonly see.

• Seizures. Common in the first days. They are treated with phenobarbital or other anti-seizure medicines, and most cooling protocols include continuous EEG monitoring so that silent seizures are caught.
• Breathing and circulation. Some babies need a ventilator and medication to support blood pressure. The oxygen shortage can also stress the kidneys, liver, and heart, so the team watches urine output and lab results closely.
• Feeding. Babies usually cannot feed by mouth during cooling. They receive IV nutrition, then feedings through a small tube, and learning to coordinate sucking and swallowing can take days or weeks after that.
• Rewarming and MRI. After 72 hours the baby is slowly rewarmed. The MRI typically follows within days to two weeks, and the neonatologist or a pediatric neurologist will go over it with you.
• Going home. Discharge can come after a week or after many weeks. Most babies leave with a plan for a developmental follow-up clinic, pediatric neurology, and often physical, occupational, or feeding therapy.

Questions worth asking the care team, and writing down the answers to:

1. What stage of HIE did you diagnose: mild, moderate, or severe?
2. Is my baby being cooled? If not, why not?
3. Has my baby had seizures on EEG, and what medicine is being used?
4. When will the MRI be done, and will you walk us through what it shows?
5. Was the placenta sent to pathology? (Ask this early. The next sections explain why.)
6. What follow-up will my baby need after discharge, and who coordinates it?

What the Long-Term Outlook Can Be

The outlook depends on severity, and the full extent of the harm takes years, not days, to become clear. Early reassurance is not a prognosis.

• Mild HIE. Mild HIE was once assumed to be harmless. It is not. Follow-up studies show that a meaningful share of these children end up suffering from cerebral palsy, difficulties with learning, attention, language, or coordination that surface in the preschool and school years, so long-term follow-up matters.
• Moderate HIE. A large share of these children develop cerebral palsy, epilepsy, learning or intellectual disability, or problems with vision, hearing, or feeding. Children do best when the injury is recognized and cooling starts quickly.
• Severe HIE. Most children with severe HIE die or are left with profound lifelong disability, and the cost of their care is correspondingly high.

The initial MRI is the gold-standard evidence and the best early predictor, but the real picture emerges over months and years. Formal developmental assessments at around 18 to 24 months and again at school age are standard, and they are also the point at which the true cost of a child’s future care starts to become measurable.

Early intervention changes trajectories. The brain is most adaptable in the first three years, and therapy started early produces better outcomes than therapy started late. In Idaho, the places to start are:

• Idaho Infant Toddler Program (ITP). The state’s early intervention program for children from birth to age three who have a developmental delay or a condition likely to cause one. Services are provided at no cost to families, and any parent can make a referral directly without waiting for a doctor to do it.
• Idaho Parents Unlimited (IPUL). Idaho’s federally funded parent training and information center. IPUL helps families navigate services, Medicaid, school evaluations, and IEPs, and advocates alongside parents.
• Hope for HIE. A national nonprofit founded and run by HIE parents, with peer support groups, a large online community, and plain-language education on every stage from the NICU through adulthood.
• Idaho Medicaid for children with disabilities. Idaho offers Medicaid eligibility for children with significant disabilities that does not depend on the parents’ income (often called the Katie Beckett program). Ask the NICU social worker or IPUL about applying before discharge.

Was This Preventable? The Question Every Parent Asks

HIE may be caused by negligence, and when the records show that, we tell families so. Sudden emergencies such as a placental abruption, a uterine rupture, or an umbilical cord prolapse are often described to families as unavoidable, but the real question in each of them is whether the warning signs were recognized, whether the team responded as fast as the situation demanded, and whether the baby was delivered as quickly as it should have been. Hospitals rarely volunteer those answers.

Most of the HIE cases we handle follow a recognizable pattern of missed warnings:

• Fetal monitoring warnings that were not acted on. The electronic fetal monitor (EFM) tracks the baby’s heart rate against the mother’s contractions. Patterns such as recurrent late decelerations, loss of variability, a rising baseline, or prolonged decelerations signal that a baby is running out of reserve. Nurses and physicians are trained to recognize these patterns and are expected to act on them before the baby is harmed, not after.
• A delayed cesarean or operative delivery after fetal distress was recognized.
• Oxytocin (Pitocin) that was continued or increased despite contractions coming too often (tachysystole), which starves the baby of oxygen between contractions.
• Undiagnosed or mismanaged complications such as preeclampsia, infection (chorioamnionitis), a post-term pregnancy, a breech baby, shoulder dystocia, or a prior cesarean scar during a trial of labor.
• Delivery-room failures. A resuscitation team that was not called or not ready, delayed or ineffective ventilation, or failure to follow the newborn resuscitation program steps.
• Missed or delayed cooling. Not recognizing encephalopathy, not drawing cord gases, or not arranging transfer in time to cool within six hours.
• Failure to properly resuscitate baby. Neonatal resuscitation must be done according to the national NRP standards, including timely and properly placed endotracheal tube intubation as necessary (ETT).

Whether your baby’s injury was preventable cannot be answered from a bedside conversation or a discharge summary, and it should not be left to the hospital’s own review of its care. It takes the complete records and independent experts in obstetrics, maternal-fetal medicine, neonatology, pediatric neurology, neuroradiology, and placental pathology. That is the work described below.

What You Can Do Now to Protect Your Family’s Options

You do not have to decide anything about a legal claim today. But a few steps taken in the first days and weeks preserve evidence that can otherwise be lost for good.

1. Ask whether the placenta was sent to pathology. The placenta is a physical record of what happened to your baby’s oxygen supply, and it can show infection, clots, bleeding, or an abruption. Hospitals routinely discard placentas within days unless a pathology exam is ordered. If it was sent, ask for the report. If it has not yet been discarded, ask in writing that it be preserved and examined.
2. Request the complete records for both mother and baby. Federal law (HIPAA) gives you the right to them. Ask specifically for the prenatal records; the labor and delivery chart; the complete electronic fetal monitoring tracings, not just the nurses’ notes describing them; the delivery note and any operative report; the delivery-room resuscitation record; cord and newborn blood gases; the full NICU chart, including cooling records and temperature logs; all EEG reports; MRI reports and the images themselves; and the discharge summaries.
3. Ask in writing that the fetal monitoring data be preserved. Monitoring tracings are often stored in a separate archiving system from the main chart. A short written request to the hospital’s medical records or risk management department makes it far less likely they are purged.
4. Write down what you remember, now. Who was in the room, what was said, when staff were called and when they arrived, how long things took, what the monitor was showing. Memories blur under stress. Dated notes do not.
5. Keep every bill, appointment, and therapy note. These document the cost of care, which is the largest part of most HIE claims.
6. Be careful what you sign, and what you post. Hospitals sometimes ask families to meet with risk management or to sign documents after a bad outcome. You can decline, or ask to have a lawyer review anything first. It is also wise to keep details of the birth off social media.

Idaho’s Deadlines and Rules Are Different From Other States

Idaho gives families less time than most states, and it adds steps that most states do not have. Five things to know:

• The two-year clock. Most Idaho medical malpractice claims must be filed within two years of the negligent act or omission (Idaho Code § 5-219(4)). The clock generally starts when the malpractice happened, not when you discovered it. Idaho has only narrow exceptions, for a foreign object left in the body or for fraudulent concealment.
• A child’s own claim gets limited extra time. Idaho pauses the clock for a minor, but only for a maximum of six years (Idaho Code § 5-230). Claims that belong to the parents rather than the child generally get no extension at all. The safe course is to treat two years from the date of birth as the deadline that matters, and to talk with a lawyer well before then, because the expert review described below takes months.
• The prelitigation screening panel. Before a lawsuit can be filed against a physician or hospital, Idaho requires the claim to go before a non-binding hearing panel convened by the Idaho State Board of Medicine (Idaho Code § 6-1001 and following). Filing with the panel pauses the statute of limitations while the panel proceeding is pending and for 30 days after it ends (§ 6-1005).
• Idaho’s community standard and expert testimony. Idaho requires proof, through qualified expert testimony, that the care fell below the standard of practice in the community where it was provided (Idaho Code §§ 6-1012 and 6-1013). Building a case means retaining physicians who familiarize themselves with how care is delivered in that Idaho community, which takes time and planning. That is a reason to involve counsel early, not a reason to wait.
• What can be recovered. Idaho caps non-economic damages, meaning compensation for pain, suffering, and loss of enjoyment of life, at an amount the Idaho Industrial Commission adjusts every July 1 under Idaho Code § 6-1603; for the year beginning July 1, 2026, the cap is $538,425. The cap does not apply to willful or reckless misconduct. There is no cap on economic damages: a lifetime of medical care, therapy, equipment, home modifications, attendant care, and lost earning capacity. In a serious HIE case, those economic losses run into the millions and make up most of what a family recovers.

How We Evaluate an HIE Case

HIE cases are among the most complex in both medicine and law, and we handle them the way the medicine demands. It starts with a conversation with the family, at no cost and in confidence, about what happened and what you have been told. If the facts warrant a closer look, we gather the complete records, including the monitoring tracings, the imaging, and the placental pathology, and have them reviewed by independent physicians: typically an obstetrician, a neonatologist, a pediatric neurologist, and a neuroradiologist, and often a maternal-fetal medicine specialist and a placental pathologist as well.

From those reviews we reconstruct what happened during labor, delivery, and your baby’s first hours, and we answer three questions in order. Did the care fall below the standard? Did that failure cause the injury? And what will this child need over a lifetime? For the last question we work with life care planners and economists to put a defensible number on medical care, therapies, equipment, home modifications, attendant care, and lost earning capacity.

We will tell you what the records show, including when we conclude that the injury was not preventable. Families deserve a straight answer either way.

Mahoney Law is a Boise, Idaho firm that represents families in birth injury and medical malpractice cases throughout Idaho. If your baby has been diagnosed with HIE and you want to understand what happened, call us or contact us online. There is no fee to talk with us, and we handle birth injury cases on a contingency basis, so your family pays nothing unless we recover compensation for you.

About This Guide

This guide is general information for families, not medical or legal advice. Your baby’s care should be guided by your medical team, and the legal rules described here apply differently depending on the facts of each case. Reading this guide does not create an attorney-client relationship with Mahoney Law. If you have questions about your own situation, contact us.