Neonatal Seizures Birth Injury Lawyers in Miami

Oxygen Deprivation During Labor: Hypoxic-Ischemic Encephalopathy (HIE)

HIE is the leading cause of neonatal seizures in full-term infants. It occurs when blood flow or oxygen delivery to the fetal brain is interrupted during labor. The electronic fetal monitor records the baby’s heart rate continuously throughout labor. When the tracing shows late decelerations, prolonged decelerations, or minimal variability, the clinical team is looking at a brain that is running out of oxygen reserve.

The question is not whether the tracing deteriorated. The question is what the obstetric team did with the information the monitor was giving them, and how much time passed between the first nonreassuring pattern and the decision to deliver. In our experience litigating these cases across Miami-Dade County, the fetal heart rate strips are the single most important piece of evidence. Our maternal-fetal medicine experts re-read them tracing by tracing, annotate every deceleration pattern, and calculate whether the clinical response matched the urgency the pattern demanded.

Untreated Maternal Infection: When Inflammation Reaches the Fetal Brain

Group B Streptococcus, chorioamnionitis, and other intrauterine infections produce inflammatory cytokines that cross the placenta and damage developing neural tissue. The maternal chart records the temperature, the white blood cell count, and the clinical findings that should have triggered antibiotic administration or expedited delivery. When the infection markers were documented and the obstetric team delayed the response, the interval between the first clinical sign and the first intervention is measurable, documented, and central to the case.

Traumatic Delivery: Instrument Injuries and Shoulder Dystocia

Forceps that compressed the skull. A vacuum extractor that caused a subgaleal hemorrhage. A shoulder dystocia where excessive traction on the head produced a brachial plexus injury alongside intracranial bleeding. These mechanical injuries can trigger seizures within hours of delivery. The operative note describes what instruments were used, how many attempts were made, and how much force was applied. When the documentation reveals that a vacuum was popped off three times and reapplied, or that fundal pressure was used during a shoulder dystocia in violation of current ACOG guidance, the mechanism connecting the delivery technique to the seizure is direct and provable.

Continuous video EEG, sometimes abbreviated cvEEG, is the gold standard for detecting neonatal seizures. Many seizures in newborns are subclinical. The baby does not convulse. The baby does not shake. The electrical activity is happening inside the brain without any visible manifestation, and only the EEG captures it. The concept of “seizure burden,” the total volume of seizure activity over a given period, is what neonatal neurologists use to assess the severity of the brain injury and guide treatment with anticonvulsant medications like phenobarbital or levetiracetam.

From a legal standpoint, the cvEEG record is a second timeline running parallel to the delivery records. It tells us when the seizures started, how frequent they were, how long each one lasted, and whether the NICU team responded to the electrographic findings in real time or whether hours of subclinical seizure activity went unrecognized because the monitoring was not being read by a qualified neurophysiologist. In Miami, we obtain the raw EEG data and retain pediatric neurologists who re-read every hour of the recording to determine whether the seizure burden was identified and treated with the urgency it required.

A baby is born following a difficult labor marked by recurrent late decelerations. Apgar scores are low at one and five minutes. The infant is admitted to the NICU. If the hospital follows the standard of care for a newborn with suspected HIE, continuous video EEG monitoring should begin within the first few hours of life, and therapeutic hypothermia (cooling) should be initiated within six hours of birth to limit the extent of the brain injury.

Now consider what happens when the standard is not met. The baby is admitted. The NICU team orders routine monitoring but does not initiate cvEEG for 18 hours. During those 18 hours, the baby is experiencing electrographic seizures that nobody sees because there is no EEG running. Cooling, which has a strict six hour initiation window supported by the landmark CoolCap, NICHD, and TOBY trials, is not started because the clinical team did not classify the injury as moderate to severe HIE in time. When our pediatric neurology experts review the case, they reconstruct what the EEG would have shown during those missing 18 hours based on the clinical trajectory and the subsequent EEG findings. The seizure burden that accumulated during the gap is brain damage that did not have to happen.

Neonatal seizures caused by HIE frequently produce cerebral palsy, epilepsy requiring lifelong anticonvulsant management, cognitive and developmental delays, and feeding difficulties that may require a gastrostomy tube. The severity depends on the extent of the hypoxic injury and the seizure burden in the first days of life. A child with mild HIE may develop learning disabilities that become apparent in elementary school. A child with severe HIE may never walk, speak, or feed independently.

The Life Care Plan we commission for each case is built by a certified planner who evaluates the child’s specific deficits and projects every category of need across the full life expectancy. Physical therapy, occupational therapy, speech therapy, and cognitive rehabilitation with frequency schedules that evolve as the child grows. Anticonvulsant medication management and neurology follow up for decades. Adaptive equipment from infant positioning systems through adult power wheelchairs. Specialized schooling, tutoring, and vocational support. Home modifications and accessible transportation. Attendant care at the level the child’s functional limitations require. A vocational economist independently calculates the income the child would have generated across a working career absent the injury. Combined, these projections produce an evidence-based number that a jury can evaluate against specific line items rather than an abstract appeal to sympathy.

The Attorney Who Prepared These Defense Arguments Before He Switched Sides

The hospital will call the seizures “idiopathic.” Their neonatologist will testify that the fetal heart rate tracing was “Category II and reassuring.” Their expert will argue that the cooling window was not missed because the injury “did not meet the criteria for therapeutic hypothermia.” Attorney Jorge L. Flores knows these arguments because he drafted versions of them during the years he spent at a Miami insurance defense firm representing hospitals against birth injury claims.

He learned which arguments hold up and which ones fracture under a properly prepared cross examination. A “Category II” tracing that persisted for 90 minutes without intervention is not reassuring. It is a tracing that required action. “Idiopathic” seizures in a baby born after a labor complicated by recurrent decelerations and low Apgars are not idiopathic. They are the predictable neurological consequence of oxygen deprivation that the monitoring system was designed to detect. Jorge Flores builds every neonatal seizure case to close the exits the defense relies on.

The Seizure Is the Alarm. The Delivery Record Explains What Triggered It.

The fetal monitoring strips, the NICU admission notes, the cvEEG data, and the cooling protocol documentation reconstruct the full picture. If the team had the information and did not act on it, the evidence already exists.

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