Do seizures after birth indicate birth injury?

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A. Yes, they often do. Neonatal seizures are seizures that occur shortly after birth or during the neonatal period, and can indicate that a birth injury occurred. In fact, seizures may be the first (and perhaps only) clinical sign of a brain injury or disorder in a newborn baby. Seizures frequently develop in babies who sustained oxygen deprivation around the time of birth.

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What are seizures?

Seizures occur when there are abnormal electrical discharges in the brain (1) that produce conditions such as convulsions, brain disturbances, and altered consciousness. Seizures after birth must be promptly diagnosed and treated; seizures are not only a sign of brain injury, but can also cause additional brain damage, thereby making an existing injury even worse.

Why do some babies have seizures after birth?

The most common cause of neonatal seizures is hypoxic-ischemic encephalopathy (HIE), a type of brain injury caused by a lack of oxygen during or near the time of birth. This fetal oxygen deprivation can be due to decreased oxygen in the baby’s blood (hypoxemia or hypoxia) and/or decreased blood flow (ischemia) to the brain. Other  causes of neonatal seizures include central nervous system (CNS) infections/ meningitis, intracranial hemorrhages (brain bleeds), birth trauma, strokes, metabolic problems, and more rarely, malformations of the cortex (2).

Unfortunately, most neonatal seizures and subsequent seizure disorders are caused by birth injuries. If a medical professional fails to do all they can to prevent a birth injury, and this causes seizures or other types of harm, it constitutes medical malpractice.

The following complications and medical errors can cause neonatal seizures (this is not a complete list):

  • Untreated maternal high blood pressure (preeclampsia): Preeclampsia is particularly dangerous because it restricts vessels that bring blood to the baby, thereby decreasing the amount of oxygen-rich blood that reaches the fetus.
  • Umbilical cord-related brain injuries: Any umbilical cord complication can seriously decrease the amount of oxygen-rich blood that reaches the baby. The umbilical cord is the baby’s lifeline to the mother. When blood is unable to travel through the cord, an unborn baby will not be able to receive oxygen. Umbilical cord injuries and complications include the following (among other problems):
    • Nuchal cord: A complication in which the cord wraps around the baby’s neck.
    • Umbilical cord prolapse: A complication in which the cord exits in front of the baby and gets compressed in the birth canal.
    • Cord compression: A complication in which the umbilical cord is compressed by pressure that decreases or obstructs the flow of blood, oxygen, and nutrients to the baby. This could be due to nuchal cord, cord prolapse, or another issue.
  • Uterine or placental complications: Problems with the placenta or uterus may include placenta previa, placental abruption, placental insufficiency, and ruptured uterus. Oxygen-rich blood travels from the mother, through the uterus and placenta, to the umbilical cord and baby. If anything prevents blood from either flowing into or out of the placenta, the supply of oxygen-rich blood going to the baby will be decreased.
  • Tachysystole (excessively frequent uterine contractions): These types of contractions can be caused by the labor induction drugs Pitocin or Cytotec. These drugs sometimes make contractions so strong and fast that there is essentially one continuous contraction that is constantly impinging on or compressing vessels in the uterus (womb) and placenta. These vessels bring blood to the baby through the umbilical cord. With excessive pressure on the vessels, the supply of oxygen-rich blood that travels to the baby can be severely reduced.
  • Complications related to the baby’s size or position may include breech presentation, cephalopelvic disproportion (baby’s head or body is too large to pass through the mother’s pelvis/birth canal), or macrosomia (the baby is larger than average).
  • Improper use of delivery instruments such as forceps or a vacuum extractors: These instruments increase the risk of brain bleeds and subsequent seizures in the baby.
  • Delayed delivery of the baby and delayed emergency C-section: If the baby is experiencing fetal oxygen deprivation, physicians must deliver the baby immediately. Failure to deliver a fetus in distress can cause permanent brain damage and HIE.
  • Prolonged labor and delivery: Labor and delivery can put stress on babies. When labor and delivery lasts for longer than is typical, the baby is at higher risk for issues such as oxygen deprivation, birth trauma, and neonatal seizures. In many cases, a C-section delivery should be performed in order to minimize these risks if labor is not progressing as it should.
  • Infection: Neonatal meningitis (brain infection) often leads to neonatal seizures. Meningitis is often bacterial and caused by Group B Streptococcus or Escherichia coli (E. coli), but there are a variety of other infections that can cause meningitis and seizures. While infants may become infected after delivery, the most common cause of neonatal infection is an undetected and untreated infection in the mother that is transmitted to the baby through the birth canal. It is the physician’s responsibility to screen for various infections during the pregnancy and provide appropriate treatment.
  • Kernicterus: There is a byproduct of red blood cell breakdown called bilirubin, which is something that all people naturally have in their bodies. Sometimes, babies have a difficult time getting rid of bilirubin, and when too much builds up in their blood, it causes jaundice. When jaundice becomes severe, there is a high chance that the bilirubin can travel to the baby’s brain. Bilirubin is toxic to brain tissue, and when it enters the tissue, a dangerous condition called kernicterus occurs. Kernicterus is a type of brain injury that can result in cerebral palsy and seizures after birth.
nuchal cord; cord around the neck; umbilical cord; fetal hypoxia; hypoxic ischemic encephalopathy, HIE; birth asphyxia; neonatal encephalopathy, intrapartum asphyxia; fetal oxygen deprivation

Nuchal cords and hypoxic-ischemic encephalopathy (HIE) can both cause neonatal seizures

Types of seizures

There are multiple ways of classifying neonatal seizures, but these are some common categories (3):

  • Subtle seizures: Subtle seizures are often difficult to see. There may be some bicycling-type movement, fixation of gaze, or repetitive facial movements when a baby experiences this type of seizure. This type of seizure comprises about 50 percent of all newborn seizures.
  • Clonic seizures: Clonic seizures in infants are typically marked by rhythmic jerking. This type of seizure represents about 25 percent of all seizures in newborns.
  • Myoclonic seizures: Myoclonic seizures may involve rapid or non-rhythmic  jerking movements, which may look similar to the Moro reflex. These seizures may be associated with severe brain damage, although some healthy babies have myoclonic movements in their sleep. Myoclonic seizures account for about 20 percent of all neonatal seizures.
  • Tonic seizures:  Tonic seizures cause sustained contractions. They can occur while the infant is awake or asleep. Tonic seizures account for about five percent of neonatal seizures.

Diagnosing seizures after birth

The primary diagnostic test for verifying seizure activity and determining the location of the brain affected is an electroencephalogram (EEG). When an EEG is performed, electrodes are attached to the baby’s head. The electrodes read the electrical activity of the brain and show the changes that occur over time. The results appear on-screen as well as on printed strips.

Other signs of birth injury

Seizures after birth are one sign that a birth injury may have occurred, but they are not the only sign. The following signs may also be cause for concern and warrant further investigation:

  • The baby is pale or blue in color after delivery
  • The baby has trouble breathing after delivery
  • The baby’s heart rate is abnormal around the time of birth
  • The baby requires resuscitation to help with breathing or heart rate
  • The baby has a low Apgar score at one minute and/or at five minutes after birth
  • The baby has an umbilical cord blood gas reading that is abnormal
  • The baby is sluggish or lethargic
  • The baby has difficulty with or no interest in feeding
  • The baby has odd movements in the face, arms, or legs
  • The baby favors one side of the body

Do I have a neonatal seizure case?

In order to avoid seizures after birth, all medical personnel must strictly follow standards of care. A mother and baby must be closely monitored during labor and delivery, and proper prenatal testing must be performed in order to avoid the conditions causing seizures after birth, such as HIE and infection. Failure to properly monitor a mother and baby and to follow standards of care is medical negligence. If a physician fails to recognize signs that a baby is having or is likely to have seizures after birth, and the seizures and their underlying causes go untreated, it is medical malpractice.

If your child was diagnosed with HIE and/or seizures after birth, a review of the medical records can determine whether negligence played a role in causing the injury. The award-winning birth injury attorneys at ABC Law Centers have experience in handling birth injury and seizure cases for clients throughout the nation, and can help your family obtain the compensation you deserve. Clients pay nothing throughout the entire legal process unless we win their case, and you’re welcome to contact us even if you aren’t yet sure whether you want to sue. Please reach out in whichever way best suits your needs:

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Related resources | birth injury and seizures after birth

Sources

  1. What Causes Epilepsy and Seizures? (n.d.). Retrieved January 29, 2019, from https://www.epilepsy.com/learn/about-epilepsy-basics/what-causes-epilepsy-and-seizures
  2. Kang, S. K., & Kadam, S. D. (2015). Neonatal seizures: impact on neurodevelopmental outcomes. Frontiers in pediatrics, 3, 101.
  3. Panayiotopoulos, C. P. (2005). Neonatal Seizures and Neonatal Syndromes. In The Epilepsies: Seizures, Syndromes and Management. Oxfordshire: Bladon Medical Publishing.