If your baby was placed on a cooling blanket in the NICU and you are still trying to make sense of what happened, you are not alone. For most parents, the hours after a complicated delivery are a blur of fear, medical terminology, and decisions being made around them. Now that you have distance from that moment, the questions are getting louder: What went wrong? Why did my baby need this? Could it have been prevented? This guide is for you.

The Short Version of What Happened

Here is the chain of events, in the simplest terms possible:

1
Something disrupted your baby’s oxygen supply during birth. This could have been a problem with the umbilical cord, the placenta, the labor process itself, or a complication that reduced blood flow to your baby. The medical term for this is birth asphyxia.
2
The medical team recognized signs that your baby’s brain may have been affected. These signs may have included low Apgar scores, difficulty breathing at birth, low muscle tone, seizures, or abnormal blood gas results from the umbilical cord.
3
Your baby was diagnosed with HIE (hypoxic-ischemic encephalopathy). This is the term for brain injury caused by oxygen deprivation. “Hypoxic” means lack of oxygen, “ischemic” means reduced blood flow, and “encephalopathy” means brain dysfunction.
4
Cooling therapy was started to protect your baby’s brain. Because a secondary wave of brain injury develops 6 to 72 hours after the initial event, cooling your baby’s body temperature to 33.5°C for 72 hours slows that cascade and limits the damage. This is the only treatment proven to reduce disability from HIE.
The fact that your baby received cooling is, in one important sense, good news. It means the medical team recognized the situation and initiated a treatment that has been proven to improve outcomes. The NICHD trial published in the NEJM showed cooling reduces the risk of death or major disability by approximately 25 percent. Many babies who receive cooling go on to develop normally.

Common Reasons Babies Need Cooling

You may or may not have been told specifically what caused the oxygen deprivation. Here are the most common reasons babies experience oxygen loss during birth:

  • Umbilical cord problems: The cord may have been compressed, wrapped tightly around the baby’s neck (nuchal cord), prolapsed ahead of the baby, or developed a true knot. Any of these can restrict or cut off blood flow.
  • Placental abruption: The placenta separated from the uterine wall before delivery, reducing or stopping the flow of oxygenated blood to the baby.
  • Prolonged or difficult labor: Extended contractions, a stalled delivery, or failure to progress can compress the cord and reduce blood flow over time.
  • Delayed delivery when the baby was in distress: If fetal monitoring showed signs of distress and the decision to deliver (often by emergency cesarean) was delayed, the oxygen deprivation may have continued longer than necessary.
  • Maternal complications: Conditions such as pre-eclampsia, chorioamnionitis (uterine infection), uterine rupture, or maternal hemorrhage can all compromise the baby’s oxygen supply.
  • Shoulder dystocia: The baby’s shoulder became stuck during delivery, delaying birth and prolonging oxygen deprivation.
You deserve to know exactly what happened. If you were never given a clear explanation, you are not being unreasonable by wanting one now. The delivery was documented in detail through fetal monitoring strips, nursing notes, physician notes, and NICU records. These documents contain the timeline of what happened and when.
Still Have Questions About What Happened?

Our team helps families understand their baby’s NICU experience and whether medical errors may have contributed. Free, confidential, no obligation.

Get a Free Case Review
CP Family Help
Get a Free Case Review
Did your baby receive cooling therapy?
Confidential · No obligation · Takes 2 min

How to Get Answers from Your Baby’s Medical Records

Your medical records and your baby’s medical records are the single most important source of information about what happened. You have a legal right to request complete copies under HIPAA, and the hospital must provide them within 30 days.

Here are the key documents to request and what each one tells you:

  • Fetal heart rate monitoring strips: These continuous recordings show how your baby’s heart rate responded during labor. Abnormal patterns (late decelerations, variable decelerations, loss of variability) indicate the baby was experiencing oxygen deprivation. The timing of these patterns and the team’s response is central to understanding what happened.
  • Labor and delivery notes: The physician and nursing notes document the timeline of labor, any complications, interventions attempted, and the decision-making process around delivery.
  • Resuscitation records: If your baby required resuscitation at birth, these records document what was done, when, and how the baby responded. They include Apgar scores and cord blood gas results.
  • Cooling initiation documentation: Records showing when the decision to cool was made, when cooling was started, and the baby’s neurological exam findings that qualified them for treatment.
  • Brain MRI report: The MRI performed after cooling is the strongest predictor of your baby’s long-term outcome. The radiology report describes what the scan showed and what it means.
  • NICU discharge summary: This document summarizes the entire NICU stay, including diagnoses, treatments, and follow-up recommendations.
A note about timing: There is no deadline for requesting your medical records. Whether your baby’s cooling was last week or several years ago, you can still obtain these documents. If you are considering a legal review, having the records in hand makes the process faster and more informative.

When the Reason for Cooling Points to Preventable Errors

Not every case of HIE is the result of medical negligence. Some complications, like a sudden placental abruption or a cord prolapse, can occur without warning despite appropriate care. But in many cases, the oxygen deprivation that led to your baby’s cooling was caused or worsened by failures in the medical team’s response.

Questions worth asking include:

  • Were the fetal heart rate patterns showing signs of distress before delivery? If so, how long before?
  • Was there a delay between the recognition of distress and the decision to deliver?
  • Was an emergency cesarean recommended but delayed? If so, why?
  • Was the cord involved (compression, prolapse, nuchal cord)? Was this recognized in time?
  • Did the hospital have cooling capability, or was a transfer needed? How long did the transfer take?
  • Was cooling started within 6 hours of birth?

A free, confidential case review looks at these exact questions. Our team works with medical experts who review the complete record to determine whether errors in care during labor or delivery contributed to the oxygen deprivation that made cooling necessary.

Get a Free, Confidential Case Review

Our team works with families across all 38 states. No cost, no commitment. Just answers.

Start Here