Hypoxic-ischemic encephalopathy (HIE) is a potentially serious complication of childbirth that results from an inadequate oxygen supply to the fetus’s brain during pregnancy, labor, or delivery. Along with behavioral disorders, developmental disabilities, epilepsy and seizure disorders, and other cognitive effects, HIE has the potential to cause vision and hearing impairments in newborns as well.
For parents of children who are diagnosed with HIE at birth, it will be important to see a specialist who can diagnose and begin treatment for all of the potential long-term effects of their child’s condition promptly. It will also be important to consult with an attorney, as the costs of long-term treatment can be insurmountable for many families, and many cases of HIE are the result of medical malpractice.
What Vision Impairments Are Associated with HIE?
There are three primary types of vision impairments that are associated with HIE. These are (i) cortical visual impairment (CVI), (ii) peripheral vision loss (or tunnel vision), and (iii) strabismus.
Cortical Visual Impairment (CVI)
Cortical visual impairment (CVI) is a form of visual impairment that results, not from dysfunction of the eyes, but rather from dysfunction of the brain. As explained by Boston Children’s Hospital:
“The diagnosis of CVI is indicated for children showing abnormal visual responses that cannot be attributed to the eyes themselves. . . Fixation and following, even to intense stimulation, may be poor and the child does not respond normally to people’s faces. Visual regard and reaching (in the child with motor capabilities) toward objects is absent.”
In newborns, symptoms of CVI include abnormal response to light, a “blunted” gaze, and brief periods of fixation with intermittent following. Treatment for CVI focuses initially on treating the underlying cognitive impairment or disorder. Treatment options for HIE (and thus CVI) can vary greatly, depending on the severity of the child’s condition and other factors. Parents who suspect CVI should consult with a specialist as soon as possible.
Peripheral Vision Loss (Tunnel Vision)
Peripheral vision loss, commonly referred to as tunnel vision, is also a potential consequence of suffering from HIE in the womb. Generally speaking, tunnel vision is permanent, although it may be possible to slow down or permanently stop the reduction in a child’s field of vision.
Strabismus is a condition that causes the eyes to face different directions. Typically, this manifests in the form of appearing cross-eyed, although there are technically four different forms of strabismus:
- Esotropia (one or both eyes facing inward toward the nose)
- Exotropia (one or both eyes facing outward in the direction of the ear)
- Hypertropia (one or both eyes facing upward toward the forehead)
- Hypotropia (one or both eyes facing downward toward the cheeks)
As summarized by the U.S. National Library of Medicine, “Six different muscles surround each eye and work ‘as a team.’ This allows both eyes to focus on the same object. In someone with strabismus, these muscles do not work together. As a result, one eye looks at one object, while the other eye turns in a different direction and looks at another object..” For newborns and young children, strabismus can negatively impact depth perception, and it can lead to vision loss (amblyopia) in one eye. This occurs when “the brain . . . learn[s] to ignore (suppress) the image from the weaker eye.”
What Hearing Impairments Are Associated with HIE?
The primary form of hearing impairment associated with HIE is sensorineural hearing loss (SNHL). As explained by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, “SNHL happens when there is damage to tiny hair cells in the cochlear and/or the auditory nerve. Sound energy reaches the cochlea, but damaged hair cells are unable to convert sound waves into neural signals that pass through the auditory nerve to the brain.” This causes hearing loss that may be permanent, and in most cases, newborns and young children diagnosed with SNHL will need to be fitted with hearing aids in order to process sound normally. In addition to hearing loss, SNHL can also cause symptoms such as:
- A “full or ‘stuffy’ sensation in the ear”
- Ringing in the ear (tinnitus)
What Are the Signs and Symptoms of HIE-Related Vision and Hearing Impairments in Newborns?
In addition to the symptoms listed for the specific health conditions discussed above, in newborns, vision and hearing impairments can lead to various other symptoms as well. While diagnosing vision and hearing impairments in newborns presents some challenges, a physician who specializes in treating these conditions in infants and young children should be able to provide your family with an accurate diagnosis. Additional signs that an infant or child under the age of one may have a vision or hearing impairment caused by HIE include:
Symptoms of Vision Impairments in Newborns
- Discoloration of the pupils (typically white or grey)
- Drooping eyelids
- Eyes fluttering or watering constantly
- Inability to track moving objects
- Unusual sensitivity to light
Symptoms of Hearing Impairments in Newborns
- Being non-responsive to loud noises
- Having difficulty hearing speech or music at a normal volume
- Not beginning to speak within the first year
These lists are not exhaustive, and it is important for parents who have concerns about HIE to obtain a comprehensive diagnosis of their child’s condition. Additionally, as certain vision and hearing impairments (and other impacts of HIE) can become progressively worse over time, parents will need to continue to carefully monitor their children’s development with the help of their family physicians.
What are the Treatment Options for Vision and Hearing Impairments Caused by HIE?
The treatment options for vision and hearing impairments caused by HIE vary widely. In some cases, the focus will be on managing the child’s disability rather than treating the underlying condition. Sometimes, it may be possible to slow or stop the worsening of a child’s impairment through aggressive treatment; and, with this in mind, parents of children diagnosed with HIE should consult with an appropriate specialist as soon as possible.
With infants and young children, in particular, treatment options and needs can range significantly from one patient to the next. In general terms, treatment options for the vision and hearing impairments discussed above include:
- Cortical Visual Impairment (CVI) – While it may be possible to mitigate the extent of cortical visual impairment by treating the child’s underlying neurological condition (i.e., HIE), CVI is a permanent condition. As such, treatment focuses on rehabilitation and management of the child’s disorder. As explained by Boston Children’s Hospital, “In all children with cerebral visual impairment, services of trained and experienced teachers are very important for the child’s development and education . . . . Referral of the child with CVI to state services for visually impaired children should be done promptly after diagnosis.”
- Peripheral Vision Loss (Tunnel Vision) – Similar to CVI, treatment for tunnel vision focuses first on attempting to slow or stop the worsening of the impairment through treating the child’s HIE and then subsequently transitioning to rehabilitation. In cases of tunnel vision caused by brain damage, there is some research to suggest that certain therapy techniques may be able to restore a child’s field of vision to a limited extent – though the viability of this treatment option will need to be assessed on a case-by-case basis.
- Strabismus – In contrast to CVI and tunnel vision, there are options available for treating strabismus and restoring a child’s vision in some cases. As outlined by the American Academy of Ophthalmology (AAO), these options include (i) strabismus surgery, (ii) eye muscle exercises, (iii) strabismus eyewear, and (iv) botulinum toxin therapy. While it is important to treat the effects of HIE promptly, in some cases, it may be advisable to delay invasive treatment for strabismus.
- Sensorineural Hearing Loss (SNHL) – Generally speaking, SNHL is a permanent condition, although surgery has proven effective to partially restore patients’ hearing in some cases. For young children, therapy and rehabilitation for SNHL generally involve the use of a hearing aid and becoming familiar with the hearing aid’s placement and operation.
Would a Medical Malpractice Claim for HIE Cover the Costs of Vision and Hearing Impairments?
Given that treatment generally focuses on rehabilitation and therapy, and thus will generally prove to be a lifelong endeavor, the costs to families can be substantial. So, if your child’s HIE was the result of medical malpractice during pregnancy or childbirth, will your family’s claim include coverage for the costs (both financial and non-financial) of your child’s vision or hearing impairment?
Fortunately, the answer to this question is, “Yes.” If your family’s doctor made a mistake that led to your child developing HIE due to oxygen deprivation, your family is entitled to recover financial compensation for all of the financial and non-financial consequences of your doctor’s mistake. This includes any and all costs associated with the treatment of vision and hearing impairments associated with HIE—even if this does not involve the treatment of your child’s HIE itself. At Berkowitz Hanna, we regularly represent Connecticut families in complex birth injury cases, and you can rely on our experience to ensure that we seek full compensation for the consequences of your doctor’s error.
In order to protect your family’s claim for financial compensation, it is important that you take action as soon as possible. This means seeking medical treatment for your child (at a different medical facility), and it also means engaging a law firm to advise you as you move forward. Has your child been diagnosed with HIE? If so, and if you have questions about your child’s treatment needs or your family’s legal rights, you should seek professional help promptly. For some additional general information about what to do following an HIE diagnosis, you can read this: Answers to 10 Important Questions about Hypoxic-Ischemic Encephalopathy (HIE).
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Our firm represents families throughout Connecticut in medical malpractice cases involving HIE and other birth injuries. To discuss your family’s legal rights in confidence, call us directly or request a free consultation online today.