Annie had an uneventful, low-risk pregnancy and decided to give birth at home. She gave birth to a beautiful baby girl whom she and her husband named Ari. Although a bit sleep-deprived, Annie had been enjoying the time she was spending with her little girl. One night when Ari was 6 weeks old, Annie’s husband called to her and said that Ari didn’t seem to be breathing right. Annie was shocked to hear her daughter making strange cries that sounded like mewing noises. When her husband said that Ari had been making those noises all night, the parents decided to rush their little girl to the emergency room.
By the time the panicked couple walked into the ER, Ari was not breathing and was making raspy mewing noises. The ER team did a quick assessment, and the next thing Annie knew, Ari was surrounded by over a dozen doctors and nurses and rushed her to the neonatal intensive care unit (NICU).
After running numerous tests and trying to stabilize Ari with oxygen, she was transferred to a specialized hospital. It was then that a surgeon sat down with Annie and her husband and gave them the devastating news: Ari was born with a congenital heart defect that was causing her body to be deprived of oxygen. Ari’s condition, called transposition of the great arteries (TGA) means that at birth, two major blood vessels were flipped, causing a large amount of blood in her body to circulate without picking up oxygen from the lungs. In many newborns, the TGA is so severe that the babies’ blood picks up almost no oxygen, the babies turn blue, and if emergent intervention doesn’t take place, the newborns will not live.
Fortunately, Ari’s parents brought her to the hospital in the nick of time. The surgeons were able to perform a balloon catheterization to stabilize her, and later, Ari underwent two open-heart surgeries to fix her critical vessel problems. More troubling news was given to the family, however. During the Ari’s medical testing, a CT scan showed that soon after birth, Ari suffered an intracranial hemorrhage (brain bleed) due to her low oxygen levels. Ari now has permanent brain damage.
If Ari had been born in a hospital and taken care of by a skilled medical team, she may have been able to avoid permanent brain damage. The team would have noticed if she was bluish, breathless, and/or had a fast heart rate and fast breathing. If they had given the newborn supplemental oxygen that did not cause an increase in her oxygen level, they likely would have suspected transposition of the great arteries or another heart problem that causes shunting (blood bypassing the lungs). Many newborn babies require a little extra oxygen after birth, and all babies have their oxygen levels easily checked by a small, simple device that is placed on the body, usually a toe. When a baby has a low oxygen level – especially if prolonged – the medical team is supposed to do a thorough investigation to determine the cause of the low oxygen level.
Had the transposition of the great arteries (TGA) been quickly diagnosed and treated, Ari’s brain bleed would have been avoided and she likely would not have experienced permanent brain damage. Indeed, when a baby has quick diagnosis and treatment of TGA, outcomes are very good.
WHAT IS TRANSPOSITION OF THE GREAT ARTERIES (TGA)?
Transposition of the great arteries (TGA) occurs when the two main arteries leaving the heart, the pulmonary artery and the aorta, are switched in position. Blood returning to the heart from the body is normally pumped from the right side of the heart through the pulmonary artery to the lungs, where it picks up oxygen to carry to the rest of the body; oxygenated blood is pumped to the body from the left side of the heart via a large vessel called the aorta.
When a baby has transposition of the great arteries, the blood returning from the body that needs oxygen actually bypasses the lungs and is pumped back out to the body. This occurs due to the reversal of the vessels. The pulmonary artery, which is supposed to carry oxygen-poor blood from the right side of the heart to the lungs, now arises from the left side and carries oxygen-rich blood returning from the lungs back to the lungs. The aorta, which is supposed to pump blood from the left side of the heart to the body, now arises from the right side and carries oxygen-poor blood back out to the body. The result of TGA is that a lot of blood does not get oxygen from the lungs, causing the baby to be deprived of sufficient oxygen.
BRAIN BLEEDS (HEMORRHAGES) IN NEWBORN BABIES
A common cause of newborn brain bleeds is a lack of oxygen in the baby’s brain. Oxygen deprivation can cause brain bleeds because when the brain receives insufficient oxygen, brain cells start to degrade. When the cells that make up the blood vessel walls start to break down, the vessels become very fragile and can rupture very easily.
The most common and serious type of brain bleed in a newborn is called an intraventricular hemorrhage (IVH). IVH is bleeding inside the brain’s ventricles. Premature babies are more susceptible to brain bleeds – especially IVH – because blood vessels and other parts of their brains are underdeveloped and are thus very fragile.
Other types of brain bleeds that babies can experience include the following:
- Subgaleal hemorrhage. This is one of the most serious types of brain bleeds in a baby and it is extracranial, which means it takes place outside of the baby’s skull. Most subgaleal hemorrhages are caused by misuse of a vacuum extractor during delivery. The suction cup of the vacuum, which attaches to the baby’s head, can rupture a vein, causing the vein to bleed into the subgaleal space, which is a space between the scalp and the skull. This type of hemorrhage is life-threatening because almost half of a baby’s blood volume can end up in the subgaleal space.
- Cerebral hemorrhage. This is a form of stroke where bleeding occurs within the brain itself.
- Subarachnoid hemorrhage. This is bleeding in the subarachnoid space which is the area between the innermost of the two membranes that cover the brain. This type of hemorrhage usually occurs in full term babies and produces seizure activity, lethargy and apnea.
- Subdural hemorrhage or subdural hematoma. This type of bleed occurs when there is a rupture of one or more blood vessels that are in the subdural space, which is the area between the surface of the brain and the thin layer of tissue that separates the brain from the skull. These ruptures are usually caused by difficult deliveries when forceps or vacuum extractors are used. Seizures, high levels of bilirubin in the blood, a rapidly enlarging head, and a poor Moro reflex sometimes occur along with subdural hemorrhages.
- Cephalohematoma (cephalhematoma). This is bleeding that occurs between the skull and its covering, starting as a raised bump on the baby’s head. A cephalohematoma usually begins a few hours after birth and can last anywhere from 2 weeks to a few months.
CAUSES OF NEONATAL BRAIN BLEEDS
Traumatic head injury and brain bleeds are often caused by the use of forceps and vacuum extractors to assist with delivery. These devices are placed directly on the baby’s head when the baby is in the birth canal and they greatly increase the baby’s risk of sustaining a brain bleed or hemorrhage. Other causes of infant brain bleeds are listed below.
- Birth asphyxia and hypoxic ischemic encephalopathy (HIE – brain injury caused by a lack of oxygen or blood flow to the brain)
- Abnormal changes in the baby’s blood pressure
- Trauma from prolonged labor. The stresses and forces of labor are traumatic for a baby. Many conditions can cause prolonged labor, and oftentimes, doctors fail to move on to a C-section delivery when it is medically necessary. During an extended attempt at vaginal delivery, the physician may use Pitocin or Cytotec to try and speed up delivery, or vacuum extractors and forceps may be used to try and facilitate delivery. All of these actions can cause a traumatic injury to the head with resultant brain bleeding.
- Trauma from a difficult birth, which can occur when a baby is large for her gestational age (macrosomic), the mother’s pelvis is too small for the size of the baby (CPD), or forceps or vacuum extractors are used to facilitate delivery
- Oxygen deprivation or head trauma from hyperstimulation caused by Pitocin or Cytotec
- Abnormal presentation, such as a breech or face presentation, that causes head trauma. Research shows that a C-section delivery is the safest way to deliver a baby in breech presentation.
Indeed, a lack of oxygen to the baby’s brain is a significant cause of infant brain bleeds, especially IVH. There are numerous events that can occur during or near the time of delivery that can cause a baby to experience oxygen deprivation / birth asphyxia. These events include the following:
- Umbilical cord compression, which can occur when the baby has umbilical cord prolapse, nuchal cord (cord wrapped around baby’s neck), a short umbilical cord and a cord in a true knot.
- Placental abruption
- Uterine rupture
- Prolonged labor
- Use of Pitocin or Cytotec
- Placenta previa
- Oligohydramnios (low amniotic fluid)
- Anesthesia mistakes
- A delayed C-section delivery when fetal distress is evident on the fetal heart monitor
- Delayed diagnosis and treatment of congenital heart problems, such as transposition of the great arteries (TGA)
BRAIN DAMAGE IN A BABY
Brain injuries affect thousands of babies in the U.S. every year, and approximately 50% or more neonatal brain injuries are caused by a lack of oxygen in the baby’s brain, called birth asphyxia. Often, birth asphyxia is caused by mismanaged conditions that occur during or near the time of delivery. Brain injury in a baby, often referred to as neonatal encephalopathy (NE), can sometimes be treated, but the medical team must quickly diagnose the brain injury and give treatment within hours of delivery. Listed below are some of the causes of brain injury in a newborn.
Causes of Infant Brain Damage
- Birth asphyxia
- Improperly treated high bilirubin levels (jaundice)
- Improperly treated neonatal hypoglycemia
- Brain bleeds and hemorrhages
- An infection that travels from the mother to the baby at birth, causing neonatal sepsis and/or meningitis
- Mismanaged breathing problems after birth, such as failing to properly intubate and place baby on a breathing machine (ventilator); untreated apnea or respiratory distress; improper settings on the ventilator, which can cause overventilation injuries such as prolonged hypocarbia
- Late or missed diagnoses of congenital heart defects (e.g., transposition of the great arteries (TGA), atrial septal defect, tetralogy of fallot)
Types of Neonatal Brain Damage
With prompt medical intervention, newborn brain injuries may not cause permanent brain damage. There is a treatment for hypoxic ischemic encephalopathy (HIE) that has been shown to prevent or minimize the severity of cerebral palsy. This treatment for HIE is called hypothermia (brain cooling) treatment, and it must be given to the baby within 6 hours of the insult to the brain that caused the brain injury. Since brain insults in newborns often occur during or near the time of delivery, hypothermia treatment must usually be given within 6 hours of birth.
Whenever a baby experiences an insult to the brain, it is crucial for the medical team to properly manage the baby’s blood pressure, intracranial pressure, heart rate, perfusion, brain circulation, oxygenation and ventilation. It is also critical for seizures to be diagnosed and treated right away because seizure activity can cause brain damage. Hypoxic ischemic encephalopathy is the most common cause of seizures in a newborn.
Brain damage in a baby can cause the following long-term conditions:
- Cerebral palsy
- Seizure disorders
- Developmental delays and learning disabilities
- Intellectual & developmental disabilities
- Motor disorders
- Periventricular leukomalacia (PVL – usually seen in premature babies)
MATERNAL DIABETES IS A RISK FACTOR FOR TRANSPOSITION OF THE GREAT ARTERIES (TGA) & BIRTH INJURIES
Preexisting diabetes in a pregnant woman is a risk factor for a baby having Transposition of the great arteries (TGA). Preexisting diabetes and gestational diabetes (diabetes first diagnosed during pregnancy) also increase a baby’s risk of experiencing a birth injury. One of the main reason that diabetes increases the risk of the baby being injured during or near the time of delivery is because diabetes can cause the baby to grow very large, which is a condition called macrosomia. Macrosomic babies often need to be delivered early by a C-section delivery. If delivered vaginally, these large babies are at risk of experiencing a traumatic head injury and brain bleed.
Babies born to mothers who have diabetes are at risk of experiencing the following conditions and complications:
- Abnormally high bilirubin levels and jaundice
- Premature birth
- A baby with macrosomia has an increased the likelihood of being delivered by vacuum extractors or forceps. Macrosomia may also result in shoulder dystocia and Erb’s palsy, or cephalopelvic disproportion (the baby’s head is too large to fit through the mother’s pelvis). These delivery problems may lead to brain bleeds and hemorrhaging as well as birth asphyxia.
- Reduced uteroplacental perfusion (RUPP). RUPP is a serious condition that affects blood flow between the mother and fetus, and it can cause harm to the health of both. RUPP is a reduction in the flow of fluids, including blood (which carries oxygen and nutrients), to and from the placenta. RUPP can cause intrauterine growth restriction (IUGR) and chronic oxygen deprivation in the baby, which can lead to HIE and conditions such as cerebral palsy.
- Neonatal hypoglycemia
- Transposition of the great arteries (TGA)
AWARD WINNING BIRTH BRAIN INJURY LAWYERS HELPING CHILDREN FOR ALMOST 3 DECADES
If you are seeking the help of a birth injury lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost 3 decades.
Birth Injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as being one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning birth injury lawyers are available 24 / 7 to speak with you.