We have written extensively about the dangers of labor and delivery anesthesia and epidurals, which can cause birth injuries and brain injury in a baby. These drugs can cause numerous problems in the mother, such as low blood pressure, which can decrease the flow of oxygen-rich blood to the baby, causing birth asphyxia. Birth asphyxia often causes hypoxic ischemic encephalopathy (HIE), brain damage and lifelong conditions such as the following:
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Learning Disabilities
- Motor disorders
A recent article in the New England Journal of Medicine describes the mounting evidence that anesthesia in children whose brains are still developing is also very dangerous. In the article, entitled “Anesthetic Neurotoxicity – Clinical Implications of Animal Models,” researchers discuss studies of children that found an association between learning problems and multiple exposures to anesthesia early in life. The authors also describes animal studies in which experiments in young monkeys and other animals showed that commonly used anesthesia and sedatives can kill brain cells, cause behavioral problems and diminish memory and learning.
Although there is no research showing that a single exposure to anesthesia and sedation can cause brain injury in a child, a physician involved in some of the studies discussed in the NEJM article stated that physicians want to make people aware of the risks of anesthesia and sedatives because they feel they have a duty to do so. Experts are recommending that surgery be performed on children under the age of 4 only when absolutely necessary. This means that an operation to remove an extra finger, for example, should be postponed until the child is older than 4. And when a young child must undergo surgery, only minimal anesthesia and sedation should be used. The medical team must pay very close attention to blood flow in the child’s brain, which means that blood pressure, heart rate, pressure inside the brain and oxygen and carbon dioxide levels must be closely monitored. Indeed, insults to the brain up until a child is approximately 3 years of age can cause brain injury and cerebral palsy.
Birth Asphyxia, Brain Damage and Cerebral Palsy in a Baby
An unborn baby gets all her oxygen from blood carried to her through the umbilical cord. Oxygen-rich blood travels from the mother through the placenta and then to the baby through a vein in the umbilical cord. Anything that affects this flow of blood can hinder the baby’s oxygenation. Thus, if the mother’s blood pressure drops or there are problems with the uterus (womb), placenta, or umbilical cord, the baby may experience birth asphyxia. In certain cases, such as a complete placental abruption or umbilical cord compression, the baby can be completely deprived of oxygen-rich blood and will then have to rely on her fetal reserves. Instances such as these are obstetrical emergencies and the baby must be delivered right away before the oxygen deprivation starts to cause brain injury, which can cause permanent brain damage, hypoxic ischemic encephalopathy (HIE) and cerebral palsy.
Listed below are some common causes of birth asphyxia and brain injury in a baby:
- Umbilical cord problems, such as a nuchal cord (cord wrapped around baby’s neck), umbilical cord prolapse, short umbilical cord and cord in a true knot
- Ruptured uterus
- Placental abruption
- Preeclampsia / eclampsia
- Placenta previa
- Anesthesia mistakes, which can cause low blood pressure in the mother, including a hypotensive crisis.
- Oligohydramnios (low amniotic fluid)
- Premature rupture of the membranes (PROM) / premature birth
- Prolonged and arrested labor
- Hyperstimulation caused by Pitocin and Cytotec can also cause oxygen deprivation that gets progressively worse.
- Fetal stroke
- Postmaturity syndrome
- Failure to quickly deliver a baby when she is being deprived of oxygen (delayed emergency C-section)
How Does Birth Asphyxia Cause Brain Injury and Cerebral Palsy?
When a baby starts to experience birth asphyxia she begins to have insufficient oxygen in her blood and tissues, called hypoxia. In addition, the carbon dioxide level also increases, which is called hypercarbia. Hypoxia causes the baby to start to generate energy without oxygen, a process called anaerobic metabolism. This and other processes that occur when the baby is oxygen-deprived cause lactic acid to build up in the baby’s blood. The high carbon dioxide level along with the lactic acid build-up cause the baby to have acidosis, which means her blood is acidic. Acidosis and hypoxia can cause decreased heart function, which can cause the baby to have very low blood pressure (hypotension) and decreased blood flow to the brain (ischemia). The insufficient oxygen level caused by the birth asphyxia causes ischemia, and the ischemia causes further hypoxia. Hypoxia and ischemia cause a series of events that disrupt the energy pathways in the cells, which leads to even more brain cell injury. The degree of brain injury in the baby depends on the severity of the birth asphyxia, how long the asphyxia lasts, the baby’s age and reserves (fetal reserves), and medical management of the baby during and after birth.
If the birth asphyxia is severe enough to injure the brain, the baby will usually develop hypoxic ischemic encephalopathy soon after birth. HIE usually starts to occur during the birthing process, with problems such as seizures and poor feeding starting to occur shortly after delivery. HIE is a brain injury that can progress to permanent brain damage and long-term conditions, such as cerebral palsy.
Babies with hypoxic ischemic encephalopathy may have the following symptoms:
- Hypotonia (baby is limp and floppy)
- Poor feeding
- Depressed level of consciousness (not alert)
- Multiple organ problems (involvement of the lungs, liver, heart, intestines, etc.)
- Poor brain stem reflexes (breathing problems, an abnormal response to light, blood pressure and heart problems)
Hypothermia Treatment Can Treat Hypoxic Ischemic Encephalopathy (HIE) and Prevent Cerebral Palsy
There is a groundbreaking treatment for hypoxic ischemic encephalopathy, but it must be given within 6 hours of the time the birth asphyxia occurred, which usually means it must be given within 6 hours of labor and delivery. The treatment is called hypothermia (brain cooling) treatment and research shows that it halts almost every injurious process that starts to occur when the brain experiences an oxygen-depriving insult. During the treatment, the baby’s brain is cooled to a few degrees below normal for 72 hours. Cooling the brain in this way has been shown to prevent cerebral palsy or reduce the severity of the condition.
Brain Injury, Cerebral Palsy and Birth Injuries
Many babies who experience birth asphyxia are diagnosed with hypoxic ischemic encephalopathy shortly after birth. Not all children with HIE end up with permanent brain damage; some children with HIE have no permanent brain injury and no long term problems. Babies who have brain damage caused by birth asphyxia / HIE frequently develop cerebral palsy, seizures, motor disorders, developmental delays, speech delays, learning disorders and intellectual disabilities.
The long-term effects a child has after experiencing birth asphyxia depend on the part of the brain injured and the severity of the injury. When a baby experiences severe or total birth asphyxia, also called acute profound asphyxia, the part of the brain injured is typically the deep gray matter. When asphyxia is abrupt and severe (acute near total), deep structures are usually damaged. These include the basal ganglia, thalamus and brain stem. When the baby experiences asphyxia that is moderate to severe and relatively prolonged (acute profound), injury will usually be seen in the cerebral cortex as well as the deep brain structures, particularly the thalami, hippocampi, putamen and dorsal part of the midbrain.
If the asphyxia is partial and prolonged (usually lasting for more than 30 minutes), there will mainly be cortical injury in the watershed and parasagittal regions of the brain, which are areas that do not have direct arterial blood supply. This can involve both gray and white matter. When a baby has periventricular leukomalacia (PVL), injury is often seen in the watershed zones in the periventricular region.
Babies can also experience partial prolonged asphyxia along with acute profound asphyxia, which causes a mixed brain injury pattern.
When a baby has hypoxic ischemic encephalopathy, hypoxic ischemic lesions and other evidence of brain damage are often eventually seen on brain scans. Depending on the nature of the birth asphyxia and the condition of the baby, lesions may be on any part of the brain mentioned above (and others), such as the basal ganglia and periventricular white matter.
Location of Brain Injury & Long-Term Outlook
The location and extent of the brain damage can help the medical team predict what type of long term problems the child may have. Listed below are areas of the brain and what bodily functions these areas help control. The 3 major parts of the brain are the cerebrum, cerebellum and brain stem, all of which contain both gray and white matter.
The surface of the cerebrum is called the cerebral cortex, which consists of multiple layers of neurons. The cerebrum includes the basal ganglia and hippocampus. Damage to the cerebrum can affect the child’s movement, cognition, reasoning, memory, perception, judgment and decision-making.
The frontal lobe of the cerebrum is responsible for voluntary movement and planning. It is also plays a critical role in intelligence and personality; in fact, researchers think it is the most important lobe for these functions. The frontal lobe also contains the motor cortex, which controls motor function (movement). The portions of the motor cortex near the top of the head control movement of the legs and feet, and the lowest parts of the motor cortex control the muscles of the face and mouth.
The parietal lobe of the cerebrum is behind the frontal lobe and contains the somatosensory cortex; injury here can affect how a child feels touch on certain parts of the body. Specific functions associated with the parietal lobe include comprehension of pain, pressure, heat, cold and touch, as well as appreciation of form.
The lobe at the side of the head is called the temporal lobe of the cerebrum. An important region of this lobe is the auditory cortex – which is connected with the ears and plays a major role in hearing. Damage to the temporal lobe can cause the child to have problems with hearing, memories and speech and language behavior.
The occipital lobe of the cerebrum is at the back of the head and contains the visual cortex, which receives information from the eyes and controls vision. Damage to this lobe can cause a child to have problems with vision, reading, and relating vision to other sensory experiences.
Cerebral palsy is a group of syndromes characterized by postural and motor dysfunction. Children who have cerebral palsy have problems with muscle control (motor control), and they struggle with movement, balance and posture. Damage to the cerebrum frequently causes a child to have cerebral palsy, particularly athetoid and spastic cerebral palsy.
The cerebellum is a tightly folded, thin layer of tissue that sits on top of a large amount of white matter. It contains a fluid-filled ventricle at the base, and at the microscopic level, there are 4 deep cerebellar nuclei embedded in the white matter. The cerebellum plays a major role in motor control (muscle control). This region of the brain does not initiate movement, but it greatly contributes to coordination of muscle movement, balance, timing and precision. The cerebellum also controls a child’s sense of position; a serious injury to the cerebellum can greatly impact a child’s ability to know where her arms and legs are in space. Damage to this part of the brain can affect a child’s ability to walk, run, maintain balance and have normal muscle tone. It can also impact a child’s fine motor function, such as the ability to hold a piece of cereal. In addition, the cerebellum is involved in some cognitive functions, such as language and attention.
Damage to the cerebellum frequently causes a child to have ataxic cerebral palsy.
The Brain Stem
The brain stem helps regulate critical bodily functions, such as breathing, heart rate and blood pressure. It is also involved in relaying information from the cerebrum and cerebellum to the rest of the body through the spinal cord. Not only does the brain stem regulate heart and lung functions, it also controls the central nervous system and plays a major role maintaining consciousness and regulating the sleep cycle.
The diencephalon, pons, midbrain and medulla oblongata make up the brainstem.
The diencephalon includes the thalamus, which relays sensory impulses from one part of the brain to another to be interpreted. Temperature, touch and pain sensation are affected by the thalamus and cortex. The hypothalamus is also located in the diencephalon, and it plays a crucial role in regulating blood pressure, heart rate, body temperature, fluid, sleep cycle and hormones. Optic nerves cross over in the thalamus, so injury here can cause a child to have vision problems.
The pons connects the medulla oblongata and the thalamus. It transmits information between the cerebrum, medulla oblongata and cerebellum. The pons also plays a major role in the depth and frequency of breathing. An injury to the pons can affect a child’s breathing, ability to close the mouth and chew, vision, hearing, and ability to have coordinated motor function in the head, neck and face.
The midbrain connects the spinal cord and brain stem to the cerebral cortex. It helps control posture, balance, hearing, visual reflexes, hearing, temperature, arousal (alertness), the sleep cycle, and coordinated movement of the head and eyes.
The medulla contains important nuclei that control essential bodily functions, and it is what connects the brain stem to the rest of the brain. It has a cardiac center that controls how fast the heart beats, a respiratory center that helps control breathing, and a vasomotor center that affects the dilation or constriction of blood vessels, thereby regulating blood pressure.
The corticospinal tracts connect the body to the motor cortex, conducting impulses from the brain to the spinal cord. These tracts control the fine motor function of the limbs, such as precise movements of the fingers and toes.
Legal Help for Cerebral Palsy, Birth Injury and Neonatal Brain Damage
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.
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.
Video: Cerebral Palsy Attorneys Discuss Delivery Room Errors and Brain Injury
Watch a video of birth injury & cerebral palsy lawyer Jesse Reiter discussing how delivery room errors can cause a baby to experience birth asphyxia, which can result in hypoxic ischemic encephalopathy (HIE), brain injury and long-term problems for the child, such as cerebral palsy and developmental delays.