Cerebral palsy can occur when a baby suffers hypoxic brain injury at birth. In Part 2 of our series, Dr. Greg Vigna and Attorney Ben C. Martin explain how therapeutic cooling, medical experts, and early intervention help determine long-term outcomes and future care needs for these children.
Therapeutic cooling is now a standard treatment for newborns with oxygen deprivation. But when delays in diagnosis or improper monitoring occur, the damage can be permanent. Families deserve to understand what happened and what support their child may require over a lifetime.
If you have questions about HIE or cerebral palsy following birth, the Vigna Law Group can help you understand your options.
Visit our website: https://vignalawgroup.com/
Call for FREE Consultation: (817) 809-9023
TRANSCRIPT:
B: I'm Ben C
V: I'm Doctor V
The Medical legal guys.
B: My name is Ben Martin. I'm a lawyer in Dallas, Texas, and we have cases all across the country. And one of the types of cases that we handle and we work and we work, are what I would call the acute birth trauma cases. Those are the cerebral palsy cases. Those are the cases where you've got a hypoxic events that lead to lower oxygen leads to brain damage.
V: Even childhood schizophrenia is associated with hypoxic brain damage because that affects the dopamine centers, which leads to some of the psychosis. So this is interesting litigation. The science has evolved to be able to show particular findings in the brain that can identify hypoxic brain damage.
B: So one of the elements of a case in every one of these cases, the future harm is there, right? You don't cure profound cerebral palsy. You don't cure autism. There are treatments for each and for both which you don't cure. So what that leads to is what we call on law damages, right? What are the future damages? One is the angst, that mental anguish, that pain and suffering, that that type of injury to that child and some instances and in some states recoverable is the angst and the mental anguish of the parents.
Right? So that's one aspect of it. The other aspect of it is crunching numbers and it's crunching numbers with respect to what is this child going to eat? What is this family going to need in the future to help defer the cost of raising this child with respect to the injured? Right. I mean, some of these folks are really in need of as doctor visa, 24 hour care, depending on the severity and level of the condition.
Some are not, but there is a full range. There is such a thing as minimal birth injuries right? There is like more minimal levels of future care needed. And then there are some that, you know, into the tens of millions of dollars and those things are all put together as part of the case so that it can be evaluated by complexity and its incompleteness.
V: Right. So, you know, as the case progresses, that's when, you know, we hire the pediatric neurology expert, the pediatric societry expert, to be able to delineate the care that the child will need their life expectancy. Many of these children developed scoliosis. And they need to have scoliosis surgery, because if you have brain damage, your spine will develop neurogenic scoliosis and that will interfere with breathing.
So these children at age 14 are getting major spine surgery. These are serious medical conditions. They get worked up. We have experts in neonatology, sports and pediatric neurology. We have a labor and delivery nursing experts have ObGyn experts. And you know, these are important cases and very expensive to bring. But we need to bring these cases.
B: And there also the experts that are crunching the numbers and economists for instance, they're looking at this future care that in that future care is determined by expertise of folks called Life care planners certified life care players, people who have gone to school for years in order to become proficient in the knowledge of what it takes with respect to a child's injuries. What it's going to take for that lifetime care. Crunching those numbers and what they're going to do is make a damage model damages model, meaning a model of socioeconomics, so that we can evaluate and networks can evaluate these cases, and that the jury can evaluate these cases when they go to trial.
V: So wait and see. You know, we don't the wait and see aspects of taking care of a child who has had a complicated delivery. Neonatal encephalopathy the that is changing. And you know, so there's three grades of neonatal encephalopathy related to hypoxic encephalopathy. There is mild, moderate and severe. And historically only the the severe and moderate neonatal encephalopathies would get therapeutic cooling. Recent study showed that children with mild who aren't therapeutically cooled because they don't meet the therapeutic cooling criteria, they perform worse that were therapeutically cool.
B: There's been a study on that, and we've talked about that study. Right. Like where these children compare to the children that had the therapeutic to like the ones that did not versus the ones that did. And what these studies are called are clinical trials, right? They're different types of them. But what this particular study did was to compare these two groups so that we now know that therapeutic cooling works if it's used. And now doctors who are able to have the knowledge that they should have now to therapeutically cool these children, they're going to have a better result in the long term. They use this technology that is now known to work.
V: It's interesting. So now the centers, the major centers are they're identifying categories of severity of presentation at birth and then at two years, they're being graded in terms of how they're performing from a developmental standpoint, so that they have all this data now to be able to to identify treatments that work. Therapeutic cooling is the only treatment that helps protect the brain. And more kids who are born hypoxic are getting therapeutically cooled because the risk of therapeutic cooling is is really it's not that risky of a procedure.
B: Oh non existent As to the risk of therapeutically cooling a child, you're not going to injure a child if you use therapeutic cooling.
V: Correct. So, Ben Martin, you know, if you were to code right now and I were to, you know, do CPR and I revive him and he goes to the ICU, he would be therapeutically cool. So people who have cardiac arrest that are revived, they're getting therapeutically cool. The adults are, you know, and so this has been around this is the standard to care and wait and see attitude, the see how the baby does.
So when we're talking about autism there are two factors that cause autism okay. That are known okay, hypoxic brain damage and genetics. You know, there's been a lot of legal opinions, expert reports regarding Tylenol and the association with autism. And from my review of the literature and the meta analysis, then the gobs of data and articles regard regarding this association of Tylenol and autism, the relative risks of the articles show that it's about 1.34.
So the questions of being exposed to autism generally won't even be admissible because it lacks a certain level of confirmation. So do you want to talk about relative risks?
B: So relative risk. I'm going to talk a little bit about something called epidemiology, what the causes of those diseases are and the way it works is that there are different levels of studies that are done to make a determination as to the incidence of whatever the illness or disease is in the in the population. So one of the things that's important is to determine what is the relative risk of a particular drug or medical device or other non-pharmaceutical cause.
Right. It's in every particular area of science, every particular area of epidemiology. They do these studies. When you get to a relative risk, you're you're actually putting a number to what are the chances I'm going to get cancer if I smoke versus somebody who does not? Part of what we do that is the Depo-Provera litigation, where it is then determined in the British Medical Journal publication March of 2024 that if you took or were injected with Depo-Provera, a birth control injection, the only birth control injection that exists there is a five and a half times relative risk.
If you have, developed a meningioma, which is a type of brain tumor, 550% chance greater that you're Depo-Provera, has caused your brain tumor as opposed to one who, does not have Depo-Provera. That's a pretty broad and pretty simple way to say it. But that's that's a relative risk.
V: So autism 1.34 is what we're kind of seeing in the literature. Okay, I'm not a epidemioigist. I just but 1.34 is kind of a problem.
B: We're not saying that in some instances that Tylenol taken during pregnancy may not have something to do with autism, have some relationship, some association with with autism, but it's a lesser relative risk than, say, something like the Depo-Provera. So it's it's kind of early in the game to say one way or the other, but certainly relative risk is important in any one of these epidemiologic issues.
V: If you have a child with low level autism who had a complicated delivery, was in the NICU and is looking at 24 hour care, was there a negligent delivery and is there diagnostic evidence of a hypoxic brain damage? So we're available again, I take first call and then shortly thereafter there will be an ObGyn discussing the birthing process and then we order records.
B: So look, if you have a situation where you have a child or you know, someone, a loved one, friend who has had a child and there was a complicated delivery, it might be worth taking a minute and chitchatting with them and letting them know that there may be some help for them, some help and some help and help be an answer.