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Infant Brain Damage At Birth
Causes of Brain Damage at Birth
Every mother and child should be carefully monitored during labor and delivery. Electronic fetal heart monitors can measure the duration and intensity of the mother’s contractions and the baby’s heart activity during and following each contraction. Healthcare providers monitor and examine these tracings to determine the well-being of the fetus during labor.
If signs are present that indicate the fetus is not receiving enough oxygen, the baby may need to be delivered as quickly as possible. When delivery is delayed, the baby may suffer from a lack of oxygen which can cause a permanent and irreversible infant brain injury.
The failure to correctly interpret a fetal heart monitoring strip is just one example of negligence that can cause your child to suffer irreversible brain damage at birth. There are many different types of birth injuries and having an attorney who understands the causes can make all the difference.
To determine if brain damage occurred, healthcare providers often use certain types of brain radiological imaging. Some types of brain radiological imaging commonly used to identify brain injuries are outlined below:
- Ultrasound - An ultrasound is a non-invasive imaging technique that scans the inside of the brain. Ultrasounds are useful in detecting brain bleeding (hemorrhage), long-standing abnormalities, or recent swelling of the brain. Ultrasounds tend to be much less invasive than MRIs and CT scans but they are not as sensitive or accurate as CT scans or MRIs for detecting a brain injury.
- CT scan - A Computed Tomography scan (“CT”), produces images by directing multiple beams of x-rays through the brain. These images are taken from different angles and then combined to create a three-dimensional picture. A CT scan is a relatively quick procedure and can identify brain swelling, and is useful for determining the location and the extent of swelling within the brain.
- MRI - Magnetic Resonance Imaging (“MRI”) is the best technique for evaluating brain injury. MRI uses the magnetic properties of water to provide images of the brain. In order to obtain an MRI, a patient must lie completely still inside of a magnetic machine. The machine uses magnetic scanning technology to take three-dimensional images of the body. As with a CT scan, an MRI can provide useful information about the timing, nature, and severity of the injury. MRIs can be used to help diagnose neonatal injuries such as hypoxic ischemic encephalopathy (HIE) and fractures.
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Types and Causes of Brain Injuries
Cephalohematoma
Cephalohematomas develop when hemorrhaging occurs between the skull and the periosteum, the outer covering of the bone. The area across the periosteum is rich in blood vessels. When these vessels rupture, blood will collect and cause swelling, bruising and discoloration.
A cephalohematoma may develop due to a prolonged second stage of labor. It may also result from excessive contractions during active labor. However, they are much more common with the use of instruments during delivery, such as a vacuum or forceps.
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Although they frequently manifest externally, cephalohematomas may be indicative of serious internal damage to the brain. Moreover, a newborn may later develop the following:
- Jaundice (yellow skin tone)
- Hyperbilirubinemia, which is a breakdown of blood cellular matter that can cause direct injury to the brain
- Anemia (low red blood count)
- Hypotension (low blood pressure)
Most cephalohematomas spontaneously resolve over the course of a few weeks without intervention as the blood clot is slowly reabsorbed into the baby’s body. However, the hematoma may harden and calcify that persists for months. Significant deformities of the skull may occur when calcification of the cephalohematoma occurs.
Subgaleal Hemorrhage
Another condition that can occur due to a prolonged labor is a hemorrhage between the scalp and the periosteum of a newborn. This is known as a subgaleal or subaponeutotic hemorrhage. The bleeding in this type of disorder tends to be more extensive and the mortality rate is much higher. This condition may present as a diffuse, fluctuant swelling of the head that shifts with movement. Expansion of the swelling due to continued bleeding may occur as well. The baby may have tachycardia (fast heart beats) due to blood loss.
Hypoxic-ischemic Encephalopathy
Hypoxic-ischemic encephalopathy (HIE) is a type of birth injury that occurs when the brain is deprived of adequate oxygen (hypoxia) and/or blood flow (ischemia) which causes brain cells to die and may result in permanent brain damage. Encephalopathy refers to an acute dysfunction of the brain. When a child experiences HIE at birth, this can lead to cerebral palsy, epilepsy, or cognitive and/or motor impairment. Many factors can cause HIE. These factors include, but are not limited to:
- Umbilical cord compression
- Preeclampsia
- Uterine problems, including irritable uterus and uterine rupture
- Placental problems, including but not limited to placental abruption
- Improper use of vacuum or forceps
Many other failures may also cause HIE. Examples include failure to:
- Perform, interpret, or properly interpret ultrasounds during the prenatal period
- Calculate or record due dates by the prenatal care provider
- Properly estimate fetal weight before labor and delivery
- Perform, interpret, or properly perform non-stress test or fetal monitoring strip
- Recognize and/or treat maternal infections such as herpes, CMV or Group B strep
- Evaluate third trimester bleeding
- Use and/or monitor the use of oxytocin/Pitocin (a drug given to help the uterus contract stronger)
- Diagnose or respond to fetal distress
- Have proper personnel present during delivery of a baby in fetal distress
- Recognize and/or respond to a detached placenta
- Recognize and/or respond to a prolapsed umbilical cord
- Recommend or perform cesarean section
- Adequately resuscitate
If the hypoxic-ischemic event occurs over hours of negligent labor, the body has a coping mechanism that will redirect blood flow from parts of the brain that control higher cognitive functioning to preserve the parts of the brain that control breathing, heart rate, and the nervous system that control basic functioning. This type of injury is called a partial-prolonged hypoxic-ischemic injury.
If a baby is suddenly and totally deprived of oxygen and blood flow, the baby’s body does not have time to adapt and the resulting injury will often occur in the deep brain structures that control breathing, heart rate, and other vital functions. This type of injury is known as an acute-total hypoxic-ischemic injury. This type of injury often has a poor prognostic factor.
Instrumental Delivery: Vacuum and Forceps
During delivery, instruments such as vacuum and forceps may be used to overcome cephalopelvic disproportion. Cephalopelvic disproportion is an anatomical mismatch between the size of the baby and the maternal pelvis. A medical professional may be liable for injury to a child due to unnecessary or excessive use of such instruments. Examples of improper use include:
- Improper application of force
- Use of the instrument on a baby who does not fit the criteria
- Use of the instrument when it is not indicated, such as when a different approach results in a better outcome for the patient (i.e. cesarean section)
Moreover, it is well documented that an operative delivery by forceps or vacuum is associated with intracranial injury, such as subdural and subarachnoid hemorrhage, and a depressed neurologic outcome of a child.
Certain conditions should be met prior to a forceps extraction:
- Completely dilated cervix
- Ruptured membranes
- Fetal head engaged and present in a position that will permit delivery
The medical professional must be trained in and familiar with the use of forceps and must have the right type of forceps available for extraction. The forceps should be used with one hand while seated, and should be used to gently guide the infant to delivery, not to pull excessively on the fetal head.
Uncommon presentations such as a face presentation, occiput posterior position, or breech are often contraindications for proceeding with an instrumented delivery.
The use of vacuum to expedite delivery of an infant is not uncommon. However, a baby should be delivered after one or two applications. If the vacuum “pops off,” it is usually an indicator that there is a mismatch between the size of the baby and the maternal pelvis. Multiple applications where the vacuum disengages from the fetal scalp are atypical and could be a sign that medical negligence has occurred.
The medical professional must also be aware of how far the baby has descended during labor to adequately gauge whether instrumental delivery is the right decision. Failing to properly determine this can result in the application of high forceps or excessive traction in the use of a vacuum. High forceps is an operative procedure that is universally condemned by the medical community.
A physician using an instrument to expedite delivery must also have a back-up plan in mind in case the delivery is unsuccessful and a caesarian section must be performed. This means he or she should notify the operating room and have a team on standby to transfer the mother and baby should the need arise. Proceeding with a delivery using forceps or vacuum with the assumption that it will work is a mistake that can cause delays in delivery if the procedure does not succeed. These delays often have devastating results for a baby.
Injury Due to Cephalopelvic Disproportion (CPD)
Cephalopelvic disproportion (CPD) may occur in two different circumstances. Absolute cephalopelvic disproportion occurs when there is a mismatch between the size of an infant and the mother’s pelvis. Think of pushing a square peg through a round hole. A large baby, a petite mother, or a combination of the two makes it extremely difficult for a natural birth to occur. Attempts to do so will put abnormal amounts of stress on both the baby and mom during labor and delivery. Gestational diabetes as well as excessive weight gain in pregnancy are indications that CPD may be present.
Relative CPD may occur in unique scenarios when a cervix is slow to dilate, especially in first time mothers, or when a baby is in an unfavorable position for delivery, such as occiput posterior or breech. These would necessitate the relative size of the pelvis to increase in order to deliver the infant.
Physicians may be tempted to force delivery using:
- Oxytocin (Pitocin) or drugs that stimulate contractions or dilation of the cervix
- An instrument such as a vacuum or forceps
This can result in catastrophic injuries to the mother and baby.
Neonatal Birth Injuries
Neonatal failures are common causes of birth injuries. Examples of neonatal failures include failure to provide:
- Proper resuscitation after a traumatic birth
- Head or body cooling
- Necessary medications
- Proper neonatal personnel such as a pediatrician or neonatologist to examine an infant during a difficult delivery
Additionally, improper monitoring of temperature, blood sugar, blood pressure, or jaundice can also cause injury. Negligence during labor and delivery may compound with negligence during the neonatal period, and may lead to a worsened outcome for the baby.
An experienced birth injury attorney can review the labor and delivery, fetal heart monitor strips and neonatal medical records to help determine if a birth injury occurred, whether the appropriate steps were taken in the neonatal period, or whether negligent care continued, making the injury all the worse.
Contact Our Birth Injury Lawyers About Your Baby’s Brain Injury
If you believe your child has suffered brain damage due to medical error or negligence, please contact us. Our Chicago birth injury lawyers may be able to help you.
Call us at (877) 262-9767 or contact us online to schedule a free consultation. We represent families nationwide and have offices in Chicago IL, Baltimore MD, New York NY, and Wilmington DE.