A baby boy named Silas was recently born completely enclosed in the amniotic sac. Silas, who was born by C-section 3 months early, looked as if he were covered by a tight sac made of a thin film. Doctors could see him in the sac, curled up in fetal position. The amniotic sac is the sac in which the baby, surrounded by amniotic fluid, develops inside the womb. When the mother’s “water breaks,” the amniotic sac breaks and the fluid rushes out. In Silas’s case, the amniotic sac did not break. Doctors were very surprised by this since the sac is usually punctured during the surgery for a C-section. Being born encased in the amniotic sac is very rare; it occurs in less than 1 in 80,000 births.
At birth, the medical team had to be very careful when cutting off the sac so that Silas would not get cut. First, the team cut a hole for the nose and mouth so he could breathe. Then they got to work removing the amniotic sac. Once removed, the physicians had to give Silas special care and help him breathe since he was premature and his lungs weren’t fully developed.
AWARD WINNING BIRTH INJURY ATTORNEYS HELPING CHILDREN WHO HAVE BIRTH INJURIES CAUSED BY MISMANAGED PREMATURE BIRTH
The attorneys at Reiter & Walsh ABC Law Centers have helped hundreds of children affected by birth injuries. Birth injury attorney 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 medica0l 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).
Many of the children helped by Jesse Reiter and his team were born prematurely. This article focuses on birth injuries caused by premature birth and how these birth injuries can be prevented.
BIRTH INJURIES ASSOCIATED WITH PREMATURE BIRTH
More than 15 million babies are born prematurely every year, and this number is rising. Babies born before 39 weeks are considered early term or premature. Premature birth should be prevented whenever possible because it places the baby at risk of having numerous medical problems. Since premature babies have underdeveloped organs, such as the lungs and brain, and fragile blood vessels, they are susceptible to birth injuries such as the following:
- Hypoxic ischemic encephalopathy (HIE). HIE usually involves damage to the basal ganglia and watershed regions of the brain, but sometimes also includes periventricular leukomalacia (PVL)
- Intraventricular hemorrhages (IVH – brain bleeds)
- Neonatal encephalopathy
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Motor disorders
Experts think that about 75% of all premature births are preventable. There are certain instances in which an early delivery is planned because the baby is affected by a medical condition that makes continuation of the pregnancy risky. But in all other instances, physicians must make every effort to prevent premature birth. Physicians should take thorough histories of expecting mothers and they should be aware of any problems that cause premature birth as well as any risk factors mothers may have for preterm delivery.
When a baby is born prior to term, certain organs aren’t fully developed, such as the brain, liver, kidneys and lungs. In addition, blood vessels are fragile, making the baby more susceptible to brain bleeds, especially intraventricular hemorrhages (IVH). Due to immature organs and body systems, a premature baby is prone to prolonged high bilirubin levels (prolonged jaundice), infection, trauma and oxygen deprivation (hypoxia), all of which can cause birth injuries and lifelong conditions, such as cerebral palsy.
Described below are some of the conditions associated with premature birth.
PREMATURE BIRTH & PERIVENTRICULAR LEUKOMALACIA (PVL)
The younger and smaller a baby is, the more susceptible she is to developing periventricular leukomalacia (PVL). Although PVL can occur in term babies, it is more commonly found in babies born preterm. Infants at the highest risk for PVL are those born at less than 32 weeks of gestational age. Periventricular leukomalacia is a type of brain damage characterized softening or necrosis (death) of the white matter portion of the brain. When this white matter dies, cysts filled with fluid may be left behind. Hypoxia and ischemia (decreased blood flow) in the brain are the main causes of PVL. Periventricular leukomalacia can be the result of an insult that occurs during or near the time of birth, such as hypoxia and ischemia, and it can also be caused by trauma that occurs during labor and delivery. PVL often leads to cerebral palsy, seizures, intellectual disabilities and developmental delays. Many of the conditions discussed below can cause PVL.
PREMATURE BIRTH & BRAIN BLEEDS / INTRAVENTRICULAR HEMORRHAGES (IVH)
Premature babies are at a higher risk for brain bleeds such as an intraventricular hemorrhage, which is bleeding into the brain’s ventricular system, where spinal fluid is produced. Preterm babies are susceptible to IVH because blood vessels in their brains are not fully developed and are fragile. IVH can also result from physical trauma during birth. If a baby is in a difficult position, such as a breech presentation, the head may get stuck in the birth canal, or the process of maneuvering the baby might injure the head and cause a bleed. In a difficult birth, physicians may utilize delivery instruments, such as forceps. When used improperly, these instruments can cause different types of brain bleeds, such as IVH, a subdural hematoma and a subgaleal hemorrhage. Indeed, a premature birth makes a breech more likely, and the difficulty of labor can cause the baby to have fetal distress and birth asphyxia, which can cause periventricular leukomalacia (PVL) and brain damage. Furthermore, bleeding in the baby’s brain can cause oxygen deprivation, PVL and cerebral palsy.
INFECTION, SEPSIS & MENINGITIS CAUSED BY PREMATURE BIRTH
Certain conditions can cause a mother’s water to break before labor begins. When this happens before term, it is called preterm PROM, or PPROM. Preterm premature rupture of the membranes frequently is the result of an infection in the vagina or uterus, and when the water breaks, the infection travels to the baby during birth.
Infections that a baby can get when PPROM occurs include the following:
- Chorioamnionits (infection of the amniotic fluid and membranes that surround the baby in the womb)
- Herpes Simplex Virus (HSV), which can cause neonatal herpes encephalitis
- Encephalitis (inflammation of the brain, most often caused by HSV)
- Group B Strep (GBS)
- Sepsis (most commonly from GBS)
- Meningitis (most commonly from GBS)
These infections can cause permanent brain injury in the baby and cerebral palsy if not properly treated.
When prematurity is caused by PPROM, the baby is susceptible to fetal distress and umbilical cord prolapse. Cord prolapse can impede or completely cut the baby off from her only source of oxygen, oxygen-rich blood being supplied to her by the umbilical cord. A prolapsed cord can cause the baby to have periventricular leukomalacia (PVL), brain damage and cerebral palsy.
PREMATURE BIRTH & RESPIRATORY DISTRESS SYNDROME (RDS)
Lung immaturity is a common cause of issues that can leave a premature baby with brain damage. A premature baby often has difficulty breathing, and one of the reasons for this is respiratory distress syndrome (RDS). In RDS, the baby’s immature lungs don’t produce enough of a lipoprotein complex called surfactant. Surfactant allows the inner surface of the lungs to expand properly. When a baby is born prematurely, the physician usually administers 3 doses of surfactant within 72 hours. The first dose is given immediately after birth, or shortly after breathing problems are revealed. Surfactant therapy has been shown to significantly reduce respiratory problems and mortality in premature babies.
Proper management of RDS typically includes giving the baby a breathing tube (called intubation) so that surfactant can easily be administered right into the baby’s lungs. If surfactant therapy is delayed or not given, or a premature baby is not given enough help to breathe, severe RDS can suddenly affect the baby, and this can cause the baby to code (go into cardiac and/or respiratory arrest). Sometimes, RDS is not properly managed, causing the baby to have long-term breathing problems and hypoxia. Proper management of RDS means giving the baby the correct doses of surfactant in a timely manner and making sure the baby is adequately breathing. This means the baby needs appropriate assistive breathing devices, which may include a breathing machine (ventilator). Mismanaged RDS can cause a baby to have birth injuries such as periventricular leukomalacia (PVL), hypoxic ischemic encephalopathy (HIE) and cerebral palsy.
PREMATURE BIRTH & NEONATAL HYPOGLYCEMIA
Premature babies are at risk of developing neonatal hypoglycemia (NH), which is a condition in which the baby’s glucose (blood sugar) falls to unsafe levels shortly after birth. Babies need glucose for energy, and the baby’s brain depends on a steady supply of it as a main source of fuel. When brain cells receive insufficient glucose, they start to die, which can cause brain damage and cerebral palsy. Neonatal hypoglycemia is easily diagnosed by drawing a small amount of the baby’s blood and testing it. The blood should be sent to a lab, but a quick bedside test can also be done in the meantime so that treatment can begin immediately, if necessary. For the majority of babies, treatment for NH is simple: a baby with NH needs extra feedings with breast milk or formula, or a glucose solution can be given through an IV if the baby is unable to be fed by mouth. For more serious cases of NH, the baby may need medication. In severe cases, surgery to remove part of the pancreas, thereby reducing insulin production, may need to be performed. Since diagnosis and treatment are usually very easy, there is no reason for a premature baby to suffer from hypoglycemia.
PREMATURE BIRTH, HYPERBILIRUBINEMIA (JAUNDICE), KERNICTERUS & CEREBRAL PALSY
Jaundice is one of the most common health problems in premature babies. Jaundice is the yellowing of skin and eyes that happens when red blood cells break down and bilirubin, a byproduct of this breakdown, floods the baby’s body. Most babies are able to metabolize (break down and utilize) bilirubin easily. In some babies, however, red blood cells break down faster than normal and the body can’t easily metabolize the bilirubin. In these babies, bilirubin builds up to dangerous levels in the blood, a condition that is called hyperbilurubinemia.
Bilirubin is a brain toxin, and when it is abnormally high, it can enter the brain and cause damage to the gray matter, especially in the basal ganglia. This is called kernicterus. Children with kernicterus usually have a dystonic or athetoid form of cerebral palsy.
Hyperbilirubinemia is easily diagnosed with simple blood tests and it is easily treatable with phototherapy or a blood exchange transfusion. The underlying condition that is causing the hyperbilirubinemia should also be treated, if possible.
PREVENTION OF PREMATURE BIRTH & BIRTH INJURIES
Indeed, premature birth greatly increases a baby’s risk of very serious birth injuries such as periventricular leukomalacia (PVL) and cerebral palsy. Thus, when a baby is born preterm, the medical team must anticipate the medical needs of the baby and quickly manage the medical problems associated with premature birth.
As discussed earlier, the best way to prevent birth injuries associated with preterm birth is to prevent premature birth from occurring. A cervical cerclage and the hormone progesterone are proven methods of premature birth prevention. In addition, infection in the mother should be quickly diagnosed and treated. Sometimes, a scheduled, early delivery is medically indicated for the health of the baby. Planned deliveries make it easier to give medications that can help prevent birth injuries associated with preterm delivery. These medications include magnesium sulfate, which helps protect the premature brain in numerous ways, and betamethasone, which is a steroid that can reduce the severity of RDS, intraventricular hemorrhages (IVH), sepsis and periventricular leukomalacia (PVL).
AWARD WINNING BIRTH INJURY ATTORNEYS HELPING CHILDREN FOR ALMOST 3 DECADES
If you are seeking the help of a premature birth attorney, 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 attorney 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 attorneys 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 attorneys are available 24 / 7 to speak with you.