Hearing that your newborn has hypoxic-ischemic encephalopathy, or HIE, can leave you with urgent medical questions and difficult questions about what happened during labor and delivery.

HIE is a form of neonatal encephalopathy caused by insufficient oxygen and blood flow around the time of birth. It can range in severity and may affect a child’s brain development, movement, learning, communication, or other functions.

But an HIE diagnosis does not automatically mean that a doctor, nurse, or hospital committed malpractice.

Determining whether an HIE injury was preventable usually requires reviewing the entire sequence of events: prenatal risks, fetal heart rate monitoring, labor medications, obstetric complications, delivery timing, newborn resuscitation, blood gas results, neurological findings, therapeutic hypothermia, imaging, and the child’s later development.

This guide explains what Kentucky families should know about HIE, cooling therapy, evidence to preserve, and the Kentucky legal rules that may apply when preventable medical negligence is suspected.

What Is Hypoxic-Ischemic Encephalopathy?

Hypoxic-ischemic encephalopathy is neonatal encephalopathy caused by a reduction in oxygen and blood flow to the newborn’s brain.

The American Academy of Pediatrics distinguishes neonatal encephalopathy from HIE.

Neonatal encephalopathy describes abnormal neurological function in a newborn and can have multiple causes. HIE is the subset caused by a perinatal hypoxic-ischemic event.

That distinction matters.

A baby can show signs of encephalopathy without medical evidence proving that oxygen deprivation was the cause.

Doctors may evaluate:

• Level of alertness
• Muscle tone
• Reflexes
• Ability to suck
• Breathing
• Seizures
• Apgar scores
• Umbilical cord blood gases
• Early blood gases
• Other laboratory findings
• EEG or aEEG findings
• Brain MRI
• Placental findings
• Events during labor and delivery

Medical experts reviewing a possible birth injury claim must consider other explanations for the baby’s condition rather than assuming that every case of neonatal encephalopathy resulted from obstetric negligence.

What Can Cause HIE Around the Time of Birth?

A baby’s oxygen supply can be affected by several obstetric emergencies or complications.

Potential events can include:

• Placental abruption
• Uterine rupture
• Umbilical cord prolapse
• Other umbilical cord complications
• Severe maternal bleeding
• Prolonged fetal heart rate abnormalities
• Certain maternal emergencies
• Complications affecting placental blood flow
• Problems occurring during labor or delivery

Some of these events can occur suddenly even when appropriate medical care is being provided.

For a legal claim, the issue is not simply whether a complication happened.

The questions are whether healthcare providers recognized the problem, responded appropriately, and avoided an unreasonable delay that caused or worsened the injury.

When HIE May Raise Questions About Medical Negligence

Potential HIE cases commonly involve several areas of investigation.

Failure to Respond to Abnormal Fetal Heart Rate Patterns

Electronic fetal heart rate monitoring can provide information about fetal status during labor.

ACOG’s current 2025 Clinical Practice Guideline on Intrapartum Fetal Heart Rate Monitoring provides an evidence-based framework for classifying and managing fetal heart rate tracings.

Depending on the pattern and the overall clinical circumstances, healthcare providers may need to:

• Evaluate possible causes
• Change maternal position
• Address excessive uterine activity
• Modify labor medications when appropriate
• Increase surveillance
• Notify or escalate to an obstetric provider
• Prepare for operative delivery
• Expedite delivery when medically indicated

An HIE investigation may examine:

• When concerning changes first appeared
• Whether the pattern worsened
• How nurses interpreted and documented the tracing
• When an obstetrician was notified
• What interventions were attempted
• Whether oxytocin was adjusted appropriately
• When the decision for delivery was made
• What happened between that decision and birth

Fetal monitoring records can therefore be among the most important evidence in an HIE case.

Delay in an Emergency C-Section

There is no single decision-to-incision number that automatically establishes malpractice.

The appropriate response depends on the maternal and fetal circumstances.

When a potentially urgent event occurs, a medical review may reconstruct:

• When fetal deterioration began
• When nursing staff recognized it
• When the physician was notified
• When the physician evaluated the patient
• When a cesarean delivery was ordered
• When the operating room was prepared
• When anesthesia began
• When incision occurred
• When the baby was delivered
• When neonatal resuscitation began

The legal issue is whether the response was reasonable given the urgency of the situation and whether a preventable delay caused or increased the brain injury.

Problems With Labor Medications

Oxytocin is commonly used to induce or augment labor.

An HIE investigation may examine:

• Oxytocin dosing
• Uterine contraction patterns
• Fetal response
• Whether excessive uterine activity developed
• Whether the medication was reduced or stopped when appropriate
• Nursing communication with the physician
• Other interventions taken in response

The complete medication administration record and fetal monitoring strip can be particularly important when these issues are disputed.

Failure to Recognize an Obstetric Emergency

Some HIE cases involve sudden events such as:

• Placental abruption
• Uterine rupture
• Umbilical cord prolapse
• Significant bleeding
• Acute fetal bradycardia

A poor outcome does not mean the event could have been prevented.

The investigation instead asks whether healthcare providers identified and responded to the emergency as reasonably as the circumstances required.

What Is Therapeutic Hypothermia?

Therapeutic hypothermia, commonly called cooling therapy, is a treatment for certain newborns with moderate-to-severe HIE.

During treatment, the infant’s body temperature is carefully lowered and maintained under intensive monitoring.

Cooling is intended to reduce secondary brain injury following a hypoxic-ischemic event.

The American Academy of Pediatrics issued an updated clinical report on therapeutic hypothermia in January 2026.

For qualifying newborns with moderate-to-severe HIE born at or after 36 weeks’ gestation, the standard approach is therapeutic hypothermia at approximately 33.5°C, initiated within six hours of birth and continued for 72 hours.

The treatment requires specialized neonatal care and monitoring.

How Soon Should Cooling Therapy Begin?

For eligible infants, the AAP recommends beginning therapeutic hypothermia as soon as possible, ideally within the first six hours after birth.

That six-hour period is important because the clinical trials establishing therapeutic hypothermia’s benefit used early treatment.

The AAP also emphasizes that hospitals and practitioners involved in newborn deliveries should have systems for:

• Promptly identifying possible HIE
• Evaluating cooling eligibility
• Beginning treatment when appropriate
• Arranging prompt transfer when cooling is not available locally

When a newborn must be transferred to another hospital, the timing of recognition, referral, transport, and cooling may become important evidence.

What if Cooling Did Not Begin Within Six Hours?

The six-hour treatment window remains the priority.

However, the AAP’s 2026 report recognizes that therapeutic hypothermia initiated between six and 24 hours after birth may be considered for some eligible infants who were not cooled earlier.

Evidence for later treatment suggests the potential benefit is smaller and less certain.

The AAP recommends discussing the possible benefits and risks with the infant’s parent or guardian when later cooling is considered.

This does not make a six-hour delay automatically negligent.

Medical experts must determine:

• Whether the infant met cooling criteria
• When qualifying findings became apparent
• Whether earlier recognition was reasonably possible
• Whether cooling was medically appropriate
• Whether a delay materially affected the outcome

Is Every Baby With Possible HIE Eligible for Cooling?

No.

Therapeutic hypothermia is a specialized treatment with defined eligibility considerations.

The current AAP report supports routine cooling for qualifying newborns with moderate-to-severe HIE born at 36 weeks’ gestation or later.

Other gestational ages require additional caution.

Infants Under 35 Weeks

The AAP does not recommend therapeutic hypothermia for infants born before 35 weeks’ gestation.

Infants at 35 Weeks

Evidence for infants born from 35 weeks through 35 weeks and 6 days is limited.

Cooling may sometimes be considered after discussion of the potential risks and benefits.

Mild HIE

The AAP states that therapeutic hypothermia for newborns with mild HIE is not currently recommended outside a research study.

That distinction matters when reviewing whether cooling should or should not have been provided in a particular case.

Does Cooling Therapy Prove That Malpractice Occurred?

No.

The AAP specifically cautions that providing therapeutic hypothermia does not itself establish that hypoxia-ischemia caused the baby’s encephalopathy.

Cooling also does not establish that healthcare providers caused the underlying event.

A legal investigation must separately determine:

• What caused the encephalopathy
• When the injury occurred
• Whether any healthcare provider violated the applicable standard of care
• Whether that violation caused or worsened the injury

What Are Umbilical Cord Blood Gases?

Umbilical cord blood gases provide objective information about a baby’s acid-base status close to the time of delivery.

Common measurements include:

• pH
• Base deficit or base excess
• pCO2
• pO2

The AAP’s current HIE guidance recommends obtaining cord blood gases for depressed newborns when possible.

If a cord gas is unavailable, the report recommends obtaining a blood gas during the first hour after birth or as soon as possible.

Blood gas results can help with cooling eligibility and later medical analysis.

But they should not be interpreted alone.

Experts may evaluate them with:

• Fetal monitoring
• Apgar scores
• Resuscitation
• Early neurological examinations
• Seizures
• Laboratory findings
• EEG
• MRI
• Placental pathology
• The complete labor and delivery timeline

Are Low Apgar Scores Proof of HIE or Negligence?

No.

Apgar scores describe aspects of a newborn’s condition shortly after delivery.

A low score may be clinically important, especially when considered with resuscitation, blood gases, neurological examination, and other evidence.

But an Apgar score by itself does not prove:

• HIE
• The cause of HIE
• Medical negligence
• When an injury occurred

The complete clinical picture matters.

What Does Brain MRI Show in an HIE Case?

Brain MRI can be an important part of evaluating a newborn after suspected HIE.

The AAP identifies neuroimaging as part of comprehensive care for infants receiving therapeutic hypothermia.

MRI findings may help doctors evaluate:

• Whether brain injury occurred
• Which regions of the brain were affected
• The apparent pattern of injury
• Other possible neurological conditions

Medical experts may consider MRI findings alongside fetal monitoring, cord gases, resuscitation, EEG findings, neurological examinations, placental pathology, and later development.

MRI cannot independently answer every question about negligence or precisely reconstruct every event during labor.

Why EEG Records Matter

HIE can be associated with neonatal seizures.

The AAP recommends that centers providing therapeutic hypothermia have continuous neuromonitoring and seizure-detection capability, preferably continuous EEG or alternatively aEEG.

Potentially important records can include:

• EEG reports
• Raw EEG data when available
• aEEG documentation
• Seizure notes
• Antiseizure medication records
• Neurology consultation notes

These records can help establish the severity and course of the newborn’s encephalopathy.

HIE Treatment Resources in Kentucky

Babies with suspected HIE may require transfer from a community hospital to a higher-level neonatal intensive care unit.

Golisano Children’s at UK — Lexington

The former Kentucky Children’s Hospital is now Golisano Children’s at UK.

UK HealthCare currently identifies its Lexington neonatal intensive care unit as a Level IV NICU with 90 beds.

UK also provides neonatal transportation and a NICU Graduate Clinic for ongoing follow-up.

Norton Children’s — Louisville

Norton Children’s Hospital operates a Level IV NICU in downtown Louisville.

Norton Children’s also publicly describes whole-body cooling as a treatment its neonatologists may use for newborns affected by decreased oxygen and blood flow following a difficult birth.

Norton Women’s & Children’s Hospital operates a Level III NICU in Louisville.

Other Kentucky Hospitals

Kentucky families may receive initial delivery or newborn care through:

• Baptist Health hospitals
• Regional medical centers
• Community hospitals
• Other local neonatal units

An infant requiring more intensive treatment may then be transferred.

The fact that a newborn was transferred to a Level IV NICU does not establish malpractice at the referring facility.

The transfer timeline may nevertheless be relevant when evaluating how quickly HIE was recognized and treated.

What Records Should Parents Save in a Possible HIE Case?

The medical record can contain thousands of pages.

Some evidence is especially important.

Prenatal Records

Request:

• Complete prenatal chart
• Maternal-fetal medicine records
• Ultrasounds
• Prenatal testing
• Maternal diagnoses
• Pregnancy risk factors
• Hospital visits during pregnancy

Labor and Delivery Records

Request:

• Complete electronic fetal monitoring strips
• Nursing notes
• Obstetric notes
• Labor flowsheets
• Oxytocin administration records
• Other medication administration records
• Cervical examinations
• Physician notification records
• Operative reports
• Anesthesia records
• Cesarean delivery timeline
• Delivery note
• Placental pathology

Objective Newborn Evidence

Request:

• Umbilical cord arterial blood gas
• Umbilical cord venous blood gas
• Apgar scores
• Resuscitation record
• Early neonatal blood gases
• Laboratory studies
• Newborn neurological examinations

HIE and Cooling Records

Request:

• HIE eligibility assessment
• Encephalopathy scoring or examinations
• Therapeutic hypothermia orders
• Cooling start time
• Temperature records
• Cooling device data
• Rewarming records
• Transfer communications
• Transport records
• Neonatology consultations

Neurological Records

Request:

• EEG
• aEEG
• Neurology notes
• Seizure documentation
• Antiseizure medication records
• Brain MRI
• Other neuroimaging

Whenever possible, preserve the actual imaging data rather than only the written radiology report.

Long-Term Records

Later documentation may become important for understanding prognosis and future needs:

• Pediatric neurology
• Developmental pediatrics
• NICU follow-up
• Physical therapy
• Occupational therapy
• Speech therapy
• Feeding therapy
• Orthopedic care
• Rehabilitation
• Neuropsychological testing
• Assistive equipment
• Developmental assessments
• School records and IEPs

Why Fetal Monitor Strips Should Be Requested Specifically

A summary in a doctor’s or nurse’s note is not the same thing as the actual electronic fetal heart rate tracing.

The complete strip allows qualified experts to independently evaluate:

• Baseline fetal heart rate
• Variability
• Accelerations
• Decelerations
• Contraction patterns
• Changes over time
• Response to interventions

For that reason, ask specifically for the complete electronic fetal monitoring record, including archived electronic data when available.

Why Transfer Records Matter

Many Kentucky HIE cases involve more than one hospital.

A newborn may be delivered in a local hospital and transferred to Lexington or Louisville for advanced neonatal care.

Potentially important evidence can include:

• Time HIE was first suspected
• Time the receiving NICU was contacted
• Time transfer was accepted
• Transport-team activation
• Cooling discussions
• Instructions provided to the referring facility
• Passive or active cooling during transfer, if used
• Time the transport team arrived
• Time the baby arrived at the receiving NICU

The AAP specifically emphasizes systems for rapid recognition and transfer because many newborns with HIE are born at facilities that do not themselves provide therapeutic hypothermia.

What Parents Can Do After an HIE Diagnosis

1. Focus on Immediate Medical Care

Medical treatment comes first.

Ask the medical team to explain:

• How severe the encephalopathy appears
• Whether the baby meets cooling criteria
• Whether cooling has started
• What monitoring is being performed
• Whether seizures have occurred
• What imaging is planned
• Whether transfer is needed

2. Request the Complete Records

Do not rely only on patient portal downloads.

Request the full records from:

• Prenatal providers
• Delivery hospital
• Obstetric practice
• Neonatal transport service
• Receiving hospital
• NICU
• Neurologists and other specialists

3. Build a Timeline

Write down what you remember while the events are still relatively fresh.

Include:

• When labor began
• When concerns were raised
• What staff told you
• When fetal heart rate problems were discussed
• When a C-section was discussed or ordered
• Delivery time
• Resuscitation
• When HIE was first mentioned
• When cooling was discussed
• When cooling began
• Transfer times

4. Preserve Electronic Communications

Keep:

• Patient portal messages
• Emails
• Discharge instructions
• Appointment summaries
• Insurance correspondence
• Photographs
• Videos
• Bills and receipts

5. Continue Developmental Follow-Up

Some effects of HIE become clearer as the child develops.

Keep records of:

• Developmental milestones
• Therapy
• Neurology appointments
• Hearing and vision evaluations
• Mobility
• Feeding
• Communication development
• Educational support

6. Have Legal Deadlines Evaluated Early

Kentucky malpractice deadlines are not accurately summarized by simply telling every family that they have “one year” or that a child’s claim can always wait until adulthood.

Different defendants and different claims can produce different deadlines.

Kentucky Law and HIE Birth Injury Claims

Kentucky’s General Medical Malpractice Deadline

KRS 413.140 generally provides a one-year limitations period for negligence or malpractice actions against covered physicians, surgeons, dentists, and hospitals.

For the medical malpractice claims identified by the statute, the cause of action is deemed to accrue when the injury is discovered or, through reasonable care, should have been discovered.

The statute also contains a five-year outside limit measured from the alleged negligent act or omission for covered claims.

Deadline analysis depends on the particular facts and defendants.

Does Kentucky Toll the Deadline for an Injured Newborn?

KRS 413.170 provides tolling for certain causes of action when the person entitled to bring the action was an infant—meaning a minor—when it accrued.

Because KRS 413.140 falls within the statutory range identified by KRS 413.170, this can significantly affect an injured child’s own medical malpractice claim.

But families should not assume that every claim associated with the birth is tolled until adulthood.

Different rules can apply to:

• A parent’s independent claim
• Wrongful-death claims
• Estate claims
• Claims involving state entities
• Claims subject to another statutory procedure

The deadline should therefore be evaluated claim by claim.

Special Rules Can Apply to State Hospitals and Providers

This can matter for HIE cases involving treatment through UK HealthCare, because the University of Kentucky is a state institution.

Under KRS 49.070, state institutions of higher education are treated as state agencies for purposes of Kentucky’s Board of Claims statutes, and the Board has primary and exclusive jurisdiction over certain negligence claims involving the Commonwealth and its agencies, officers, agents, or employees acting within the scope of employment.

KRS 49.120 contains its own deadline rules.

For medical malpractice claims before the Board:

• Claims generally must be filed within one year after accrual.
• Accrual includes a discovery rule for medical malpractice.
• The statute contains a three-year outside period.
• A guardian, next friend, or other qualified representative must bring a claim for a minor within the Board’s applicable period.

Importantly, KRS 49.120 states that its rule for people under legal disability applies notwithstanding KRS 413.170.

Whether a particular doctor, employee, contractor, hospital entity, or claim actually falls within Board of Claims jurisdiction requires legal analysis.

Families should therefore not assume ordinary infancy tolling governs a potential claim involving a state institution.

Kentucky’s Certificate-of-Merit Requirement

Kentucky also has a specific filing requirement for many medical malpractice lawsuits.

Under KRS 411.167, a claimant commencing a covered medical malpractice action generally must file a certificate of merit with the complaint.

The certificate ordinarily states that:

• The facts have been reviewed
• The claimant or attorney consulted at least one qualified medical expert
• The expert is knowledgeable about the relevant issues
• The consultation provides a reasonable basis to commence the action

The statute contains exceptions and alternative procedures for certain circumstances.

For birth injury cases, an especially relevant provision is that the statute expressly addresses requested medical records, including fetal heart monitor strips and imaging studies.

Is a Kentucky Medical Review Panel Required?

No.

Kentucky previously adopted a mandatory medical review panel process.

In Commonwealth ex rel. Meier v. Claycomb, the Kentucky Supreme Court held that law unconstitutional because it improperly delayed access to Kentucky courts.

The old medical review panel process therefore is not required.

It should not be confused with Kentucky’s separate certificate-of-merit requirement, which remains important.

Do HIE Cases Usually Require Medical Experts?

Yes, in most cases.

HIE litigation involves complicated medical issues outside ordinary experience.

Depending on the case, experts may be needed in:

• Obstetrics
• Maternal-fetal medicine
• Labor and delivery nursing
• Neonatology
• Pediatric neurology
• Neuroradiology
• Placental pathology
• Rehabilitation medicine
• Life-care planning

Experts may address:

• Standard of care
• Fetal monitoring
• Delivery timing
• Cooling eligibility
• Causation
• Timing of brain injury
• MRI findings
• Long-term prognosis
• Future care needs

Kentucky Rule of Evidence 702 governs expert testimony.

Who Could Be Responsible for Preventable HIE?

Potential responsibility depends on the evidence.

A review may examine care provided by:

• Obstetricians
• Maternal-fetal medicine physicians
• Family physicians providing obstetric care
• Midwives
• Labor and delivery nurses
• Residents or fellows
• Anesthesiology providers
• Neonatologists
• NICU staff
• Hospitals or health systems

Potential hospital issues may include:

• Staffing
• Monitoring practices
• Escalation procedures
• Communication
• Emergency response
• Operating-room availability
• Transfer systems
• Institutional policies

The fact that one of these providers participated in the delivery does not establish negligence.

Can the Hospital Be Responsible or Only the Doctor?

Potentially either, both, or neither.

A medical and legal investigation may ask:

• Who made the relevant decisions?
• Who was responsible for monitoring?
• Who employed the providers?
• Were escalation procedures followed?
• Did hospital systems contribute to delay?
• Was appropriate neonatal expertise available?
• Should a transfer have occurred?
• Was the individual an employee, agent, contractor, or state employee?

Hospital responsibility depends on the particular facts and legal relationships.

What Damages Can Severe HIE Cause?

Moderate or severe HIE can result in substantial lifelong needs.

Depending on the child’s outcome, future needs may involve:

• Neurological treatment
• Physical therapy
• Occupational therapy
• Speech therapy
• Feeding therapy
• Nursing assistance
• Mobility equipment
• Communication devices
• Seizure treatment
• Home accessibility modifications
• Transportation needs
• Educational support
• Personal assistance
• Future medical care

Potential damages in a Kentucky case depend on what the evidence and applicable law support.

Serious cases may involve life-care planners, physicians, therapists, economists, vocational specialists, and other experts.

There is no responsible way to determine the value of an HIE claim from the diagnosis alone.

What if HIE Results in a Child’s Death?

Kentucky wrongful-death claims are governed in part by KRS 411.130.

The statute provides that the action is prosecuted by the deceased person’s personal representative.

Wrongful-death claims involve different procedural and deadline questions from an injured child’s personal malpractice claim.

Parents should not rely on the ordinary infancy-tolling analysis when evaluating a wrongful-death deadline.

Frequently Asked Questions About HIE in Kentucky

What is HIE?

HIE is neonatal encephalopathy caused by insufficient oxygen and blood flow associated with a perinatal hypoxic-ischemic event.

Neonatal encephalopathy can have other causes, so medical evaluation is needed to determine whether hypoxia-ischemia actually caused the baby’s condition.

How quickly should therapeutic hypothermia start?

For qualifying infants with moderate-to-severe HIE born at or after 36 weeks, the AAP recommends beginning therapeutic hypothermia as soon as possible and ideally within six hours after birth.

Standard treatment continues for 72 hours.

Can cooling be started after six hours?

Sometimes.

The AAP states that cooling between six and 24 hours may be considered for certain eligible infants after discussion with the parents about the smaller and less certain potential benefit and associated risks.

Early recognition and treatment within six hours remain the priority.

Should babies with mild HIE receive cooling?

The AAP’s 2026 report states that therapeutic hypothermia for mild HIE is not currently recommended outside a research study.

Does cooling prove my baby suffered oxygen deprivation?

No.

The AAP specifically states that receiving therapeutic hypothermia does not by itself confirm that hypoxia-ischemia caused the encephalopathy.

Does cooling prove medical malpractice?

No.

A malpractice investigation separately considers whether a healthcare provider departed from the standard of care and whether that departure caused an injury.

Which records are most important in an HIE case?

Frequently important records include:

• Complete fetal heart rate tracings
• Labor and delivery chart
• Oxytocin records
• Physician-notification records
• Cesarean timeline
• Cord blood gases
• Apgar scores
• Resuscitation records
• Early blood gases
• Cooling eligibility assessments
• Cooling records
• Transfer records
• EEG
• Brain MRI
• NICU notes
• Placental pathology

Can an abnormal fetal monitor strip prove malpractice?

Not by itself.

Fetal heart rate patterns must be interpreted in context.

Experts may consider the type of tracing, duration, maternal condition, stage of labor, interventions attempted, progression over time, and delivery circumstances.

Is there a required number of minutes for an emergency C-section?

There is not a single number that automatically establishes negligence in every case.

The appropriate timing depends on the clinical circumstances and urgency.

The analysis focuses on whether the response was reasonable for the maternal and fetal condition.

Does a low cord pH prove malpractice?

No.

Cord blood gas abnormalities can be important evidence of a newborn’s condition near delivery, but they must be considered with fetal monitoring, resuscitation, neurological findings, imaging, and the overall timeline.

Can HIE lead to cerebral palsy?

HIE can result in long-term neurological impairment, including cerebral palsy in some children.

But cerebral palsy has many possible causes.

The CDC notes that lack of oxygen during birth accounts for only a small proportion of cerebral palsy cases overall.

Which Kentucky hospitals provide advanced NICU care?

Kentucky has advanced neonatal care at several hospitals.

Golisano Children’s at UK in Lexington operates a 90-bed Level IV NICU.

Norton Children’s Hospital in Louisville also operates a Level IV NICU and publicly describes whole-body cooling among neonatal treatments for babies affected by reduced oxygen and blood flow.

Other Kentucky hospitals provide different levels of neonatal care and may transfer infants requiring more advanced treatment.

What is the statute of limitations for a Kentucky HIE case?

Kentucky medical malpractice claims against covered private physicians and hospitals generally fall under the one-year rule in KRS 413.140, including its discovery provisions.

KRS 413.170 may toll certain claims belonging to a minor.

Different rules can apply to claims involving state institutions, wrongful death, parents’ separate claims, and other circumstances.

There is no safe universal deadline that applies to every HIE case.

Does Kentucky require a medical review panel?

No.

Kentucky’s former mandatory medical review panel law was struck down by the Kentucky Supreme Court.

Does Kentucky require a certificate of merit?

For many medical malpractice lawsuits, yes.

KRS 411.167 generally requires a certificate of merit to be filed with a covered medical malpractice complaint, subject to statutory exceptions and alternative procedures.

How Morrin Law Office Evaluates a Possible HIE Case

An HIE investigation should start with the medical evidence rather than assumptions about what went wrong.

Our review may involve:

1. Obtaining the complete medical record, including fetal monitor strips, blood gases, imaging, and NICU records.
2. Collecting records from every facility involved in delivery, transport, and neonatal care.
3. Building a minute-by-minute clinical timeline where the circumstances require it.
4. Reviewing fetal monitoring and labor-management issues with appropriate medical experts.
5. Evaluating therapeutic hypothermia eligibility and timing.
6. Reviewing cord gases, neurological findings, EEG, and MRI evidence.
7. Considering alternative medical explanations for the child’s encephalopathy.
8. Identifying potentially responsible parties and legal relationships.
9. Evaluating Kentucky filing requirements, including the certificate-of-merit rule.
10. Analyzing which limitations period applies, particularly when a state-affiliated institution may be involved.
11. Documenting the child’s long-term treatment and support needs.

Not every HIE diagnosis supports a medical malpractice claim.

The purpose of the investigation is to determine whether qualified medical review supports a preventable departure from appropriate care and a causal connection to the child’s injuries.

Talk With Morrin Law Office About an HIE Birth Injury

If your baby was diagnosed with HIE and you are concerned that a delay or medical error may have contributed to the injury, Morrin Law Office can review the available information and discuss whether further investigation is appropriate.

Morrin Law Office
214 W. Main St.
Richmond, KY 40475
Phone: 859-358-0300

Related Morrin Law Resources

• Kentucky Attorney for Accidents Involving Injuries
• Kentucky Wrongful Death Lawyer
• Lexington Personal Injury & Accident Attorney
• Louisville Wrongful Death Attorney
• Richmond Wrongful Death Attorney

Sources

• American Academy of Pediatrics — Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Clinical Report (2026):
  https://publications.aap.org/pediatrics/article/157/2/e2025073627/206158/Therapeutic-Hypothermia-for-Neonatal-Hypoxic
• American College of Obstetricians and Gynecologists — Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management (2025):
  https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2025/10/intrapartum-fetal-heart-rate-monitoring-interpretation-and-management
• American College of Obstetricians and Gynecologists — Fetal Heart Rate Monitoring During Labor:
  https://www.acog.org/womens-health/faqs/fetal-heart-rate-monitoring-during-labor
• American Academy of Pediatrics — Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation:
  https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of
• CDC — Cerebral Palsy Risk Factors:
  https://www.cdc.gov/cerebral-palsy/risk-factors/index.html
• CDC — About Cerebral Palsy:
  https://www.cdc.gov/cerebral-palsy/about/index.html
• Kentucky Revised Statutes — KRS 413.140, Medical Malpractice Limitations and Discovery Rule:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49037
• Kentucky Revised Statutes — KRS 413.170, Infancy and Disability Tolling:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17873
• Kentucky Revised Statutes — KRS 411.167, Certificate of Merit for Medical Malpractice Actions:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49312
• Kentucky Revised Statutes — KRS 411.130, Wrongful Death:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17769
• Kentucky Revised Statutes — KRS 49.070, Board of Claims and State Institutions:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51456
• Kentucky Revised Statutes — KRS 49.120, Board of Claims Filing Deadlines:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51461
• Kentucky Rule of Evidence 702 — Expert Testimony:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=20402
• Kentucky Supreme Court — Commonwealth ex rel. Meier v. Claycomb (2018):
  https://law.justia.com/cases/kentucky/supreme-court/2018/2017-sc-000614-tg.html
• UK HealthCare — Golisano Children’s at UK Neonatal Intensive Care Unit:
  https://ukhealthcare.uky.edu/golisano-childrens-uk/services/neonatal-intensive-care-unit
• Norton Children’s — Neonatal Intensive Care Unit:
  https://nortonchildrens.com/services/nicu/
• Norton Children’s — NICU Locations:
  https://nortonchildrens.com/services/nicu/locations/
• Norton Children’s — Reasons a Baby May Need NICU Care / Whole-Body Cooling:
  https://nortonchildrens.com/news/reasons-why-your-baby-may-go-to-the-nicu/

Disclaimer

This page provides general public information about hypoxic-ischemic encephalopathy, birth injury, and Kentucky medical malpractice law. It is not medical advice or legal advice.

HIE treatment decisions require individualized medical judgment. Laws, medical guidance, hospital capabilities, filing requirements, and deadlines can change.

If your newborn may have HIE, rely on the treating medical team for immediate medical decisions. If you have questions about potential legal rights or filing deadlines, consider obtaining individualized legal advice promptly.