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Since 1979, Dov Apfel has been passionate about advocating for birth injury and medical malpractice victims. Mr. Apfel’s career-long record of achievements in birth injury litigation, education, and advocacy has been recognized by the Executive Board of the Birth Trauma Litigation Group of the American Association for Justice. His expertise is demonstrated by his numerous awards, presentations on birth injury topics at legal conferences for organizations like the AAJ and ATLA, and articles published by Trial Magazine and many others.
Read Bio
Since 1979, Dov Apfel has been passionate about advocating for birth injury and medical malpractice victims. Mr. Apfel’s career-long record of achievements in birth injury litigation, education, and advocacy has been recognized by the Executive Board of the Birth Trauma Litigation Group of the American Association for Justice. His expertise is demonstrated by his numerous awards, presentations on birth injury topics at legal conferences for organizations like the AAJ and ATLA, and articles published by Trial Magazine and many others.
Key Takeaways
Cooling therapy lowers a baby’s body temperature to prevent further brain damage after oxygen deprivation (HIE). This treatment significantly improves survival rates and reduces the risk of severe disabilities like cerebral palsy and blindness.
Cooling therapy must begin within six hours of birth to be effective. The sooner it starts, the better the outcome. Delays in diagnosis and treatment can worsen brain injury and lead to lifelong consequences.
HIE is often caused by preventable medical errors, such as failure to perform a timely C-section or monitor the baby’s distress. Families may be eligible for legal compensation to cover long-term care and hold healthcare providers accountable.
Hearing that your newborn has hypoxic-ischemic encephalopathy (HIE) can turn everything upside down. One moment you’re meeting your baby, and the next you’re trying to make sense of medical terms, monitors, and urgent decisions. If cooling therapy has been mentioned, it’s completely natural to feel unsure about what it means and whether everything happened the way it should have.
This guide explains what cooling therapy for babies with HIE is, how it works, who qualifies, and what the treatment process looks like. It also covers why timing matters and what questions may come up if care was delayed or not provided.
If something doesn’t feel right or you’re looking for answers, you can call 312-332-2872 to talk through your situation.
What Is HIE?
Hypoxic-ischemic encephalopathy (HIE) is a type of brain injury that happens when a baby’s brain doesn’t get enough oxygen and blood flow around the time of birth. For many parents, this is the first time hearing the term, often in an already overwhelming moment.
Below are the stages of hypoxic-ischemic encephalopathy and the associated symptoms:
- Stage I: Mild Babies may be more alert or irritable, with feeding or muscle tone changes; symptoms often improve within a few days.
- Stage II: Moderate Babies may be very sleepy, have trouble breathing or feeding, and may experience seizures.
- Stage III: Severe Babies may be unresponsive, require breathing support, and face serious complications.
Not every case is tied to a medical mistake. But sometimes, HIE can be linked to complications during labor or delivery that may not have been recognized or addressed in time.
What Is Cooling Therapy for Babies With HIE?
Cooling therapy, also called therapeutic hypothermia, is the standard treatment for eligible newborns with moderate to severe HIE. It’s designed to slow the processes that can cause further brain injury after oxygen loss.
In simple terms, HIE often involves:
- An initial event where oxygen is reduced
- A second phase, where the body’s response can cause additional damage
Cooling therapy helps interrupt that second phase. During treatment:
- Your baby’s temperature is lowered to about 92–93°F
- The temperature is maintained for about 72 hours
- The body is then slowly warmed
The process can look intense, but cooling therapy is a well-established approach focused on protecting your baby’s brain during a critical period.
Who Is Eligible for Cooling Therapy for HIE?
Cooling therapy is not appropriate for every newborn. It’s typically used when certain signs suggest a baby may benefit, and those need to be evaluated quickly after birth.
In general, it’s considered for babies born at or near full term who are showing signs of oxygen deprivation during or around delivery. Premature babies are often not eligible for cooling therapy because their bodies may not tolerate the treatment in the same way. Other signs of HIE may include:
- Low Apgar scores
- Trouble breathing or needing resuscitation
- Abnormal blood gas levels
- Weak muscle tone
- Seizures or unusual neurological responses
The medical team is responsible for recognizing these signs, determining eligibility, and starting treatment as quickly as possible when appropriate.
Why the Six-Hour Window for Cooling Therapy Is Critical
Cooling therapy is most effective when started within six hours of birth, which is the standard treatment window. During that time, the medical team must recognize possible signs of HIE, evaluate your baby, determine whether the criteria for cooling therapy are met, and begin treatment. If the hospital is not equipped to provide cooling therapy, this may also involve arranging a transfer to a facility that can.
Because of how time-sensitive this process is, clear communication and quick decisions are essential. Delays in recognizing HIE, gaps between providers, or delays in transfer can affect whether treatment begins in time. When those breakdowns happen, it can raise questions about whether the appropriate standard of care was followed during a critical period. If you have questions about how quickly care was provided, a Chicago birth injury lawyer can help talk you through the timeline.
What to Expect During Cooling Therapy in the NICU
Seeing your baby in the NICU during cooling therapy can feel overwhelming. The monitors, wires, and equipment can be a lot to take in, and it’s completely normal to feel anxious.
During treatment, your baby is placed on a cooling blanket or mattress to lower and maintain their temperature. You may see monitors tracking heart rate, oxygen levels, and brain activity, along with IV lines or breathing support. While it can look intense, each part of that setup allows the team to watch your baby closely and respond quickly. It’s constant, attentive care focused on protecting your baby.
You may not be able to hold your baby right away, but you’re still part of their care; staying close, talking to them, and asking questions can help you stay connected through it.
Cooling Therapy Risks and What Doctors Monitor
Cooling therapy is widely used and supported by clinical research, and it can improve outcomes for many babies. At the same time, like any medical treatment, it does carry some risks, which is why close monitoring is such an important part of the process.
During treatment, the team typically watches for:
- Changes in heart rate
- Breathing difficulties
- Blood pressure shifts
- Blood clotting issues
- Electrolyte imbalances
These are not uncommon in critically ill newborns, and monitoring helps the team respond quickly to any changes and keep your baby stable.
Careful monitoring is not just a medical priority. It also plays a role in evaluating whether the care provided met expected standards during a very sensitive period.
What Cooling Therapy Can and Cannot Do for HIE
Cooling therapy can improve outcomes for many babies with HIE, especially when started quickly. But it is not a cure, and it does not guarantee a full recovery.
| What Cooling Therapy Can Do | What Cooling Therapy Cannot Do |
| Help reduce the risk of further brain injury | Reverse damage that has already occurred |
| Improve the chances of better neurological outcomes | Guarantee normal development |
| Slow down harmful processes after oxygen loss | Eliminate the need for ongoing care or monitoring |
| Provide a critical window of protection during early injury | Prevent all long-term complications |
Some children still experience developmental or neurological challenges, even with timely treatment. If there were delays in starting therapy, gaps in monitoring, or other setbacks in care, those situations may raise questions about whether the care provided met expected standards.
When a Failure to Treat HIE May Be Medical Malpractice
Not every case of HIE involves medical malpractice. But in some situations, questions come up about whether the care provided met expected standards, especially during the crucial hours before and after birth.
Potential concerns may include:
- Delays in recognizing oxygen deprivation
- Inadequate monitoring during labor and delivery
- Delays in performing an emergency or untimely C-section
- Failure to evaluate for cooling therapy
- Delays in starting treatment within six hours
- Communication breakdowns between providers
- Delays in transferring to a facility that offers cooling therapy
These situations are complex, and the details matter. Understanding what happened often involves reviewing records and timelines from a very narrow window of time.
If you have questions about your child’s care or whether something may have been missed, speaking with a legal team can help bring clarity. You can call 312-332-2872 to talk through your experience and better understand your options.
How Levin & Perconti Has Helped Families in HIE Cases
Families facing an HIE diagnosis are often dealing with more than medical uncertainty. There can be emotional strain, long-term care concerns, and financial pressure all at once. It’s a lot to carry, especially when questions remain about what happened during delivery or shortly after.
At Levin & Perconti, we’ve handled complex birth injury cases involving delays in care, missed warning signs, and failures to act within critical time windows.
- $40 million verdict for a child who suffered a severe brain injury due to a delayed C-section
- $27 million verdict for a child who suffered preventable HIE and asphyxia at birth
- $11.5 million settlement for a child who suffered a catastrophic hypoxic-ischemic brain injury
These cases are not just about outcomes. We focus on understanding what happened and helping families move forward with support. Our firm has recovered over $1 billion in verdicts and settlements. Consultations are free, and there is no fee unless we win.
Talk Through Your Child’s HIE Diagnosis
Every family’s experience with HIE is different, and the questions that follow can feel just as overwhelming as the diagnosis itself. Taking time to understand what happened and what options may be available can be an important step forward.
If you’re trying to understand what happened or what your options may be, you can call 312-332-2872 to speak with someone at Levin & Perconti who can help you talk through your situation.
