The causes of newborn brain injuries vary greatly. Most commonly, neonatal brain damage is either caused by trauma to the baby’s brain and skull and/or a lack of oxygen flow to the baby’s brain near the time of birth. Hypoxic-ischemic encephalopathy (HIE) is a dangerous type of neonatal brain injury that is caused by a lack of oxygen in the baby’s blood (hypoxemia/hypoxia) or a restriction of blood flow in the baby’s brain (ischemia). Complications during labor and delivery that can cause HIE usually involve problems with the umbilical cord, placenta, and uterus (womb). Brain bleeds (intracranial hemorrhages) are an example of a neonatal brain injury caused by traumatic force to the baby’s skull or brain. Brain bleeds can be caused by misuse of forceps or vacuum extractors, abnormal fetal presentation (such as a transverse lie, breech, or face presentation), prolonged labor, and other complications. If physicians pay close attention to the baby’s heart rate on the fetal heart monitor, and if they follow other standards of care–especially when forceps and vacuum extractors are used–birth injuries and brain damage can be prevented. The key is to quickly deliver the baby as soon as fetal distress is evident on the heart monitor. A lack of oxygen to the baby’s brain will manifest as fetal distress on the monitor, also called a non-reassuring heart tracing. An emergency C-section is usually the fastest and safest way to deliver a baby who is in distress.
Causes of Newborn Brain Injuries
Listed below are some complications and injuries that, if not properly managed, can cause brain damage in a baby.
- Vacuum extraction delivery: A vacuum extractor is a small cup that is placed on the baby’s head so the physician can apply gentle traction to help move the baby out of the birth canal. Vacuum extractors can be risky devices, and specific criteria must be met before physicians use them. The pressure of the suction cup can cause a type of brain bleed called a subgaleal hemorrhage. This occurs when the vacuum ruptures a vein which then bleeds into the space between the scalp and the skull, causing severe oxygen deprivation. If the bleed is not properly managed, almost half of the baby’s blood volume can end up in the subgaleal space. A vacuum extractor can also cause intracranial hemorrhages, clots, strokes, and skull and spinal cord trauma.
- Forceps delivery: Forceps look like salad tongs and are applied to each side of the baby’s head to assist in vaginal delivery. Forceps must be precisely placed on the baby’s head, and it is critical that the physician not apply too much force. Forceps are not commonly used, so many physicians lack skill in using them. Forceps can cause trauma to the skull and spinal cord, as well as brain bleeds, clots, and hemorrhages.
- Infection: An infection in the mother that travels to the baby at birth can cause injury to cells in the baby’s brain, thereby placing the baby at risk of having a brain bleed. Infections can also cause problems with the baby’s blood flow, leading to a decreased flow of blood in the brain. These dangerous infections include chorioamnionitis, Group B strep (GBS), herpes simplex virus (HSV), Staphylococcus (staph) infections and E coli. Sepsis is an infection in the baby’s blood stream often caused by GBS and chorioamnionitis, and it can cause meningitis, which is an infection of the brain and central nervous system.
- Umbilical cord problems, such as a prolapsed umbilical cord, the cord being wrapped around the baby’s neck (nuchal cord), a short umbilical cord, and the cord being in a true knot are all potential causes of neonatal brain injury. The umbilical cord vein is the final pathway of oxygen-rich blood traveling from mother to baby. Problems with the cord can cause the baby to be partially or completely cut off from the supply of oxygen-rich blood.
- Placental abruption: Placental abruption occurs when the placenta tears away from the uterus (womb). Oxygen-rich blood traveling from the mother to the baby moves through vessels in the womb and placenta and then into the umbilical cord to be transported to the baby’s circulatory system. Problems with the uterus or placenta can significantly decrease the amount of blood traveling to the baby from the mother. In some cases, such as when there is a complete placental abruption, the baby may not be able to receive any oxygen-rich blood from the mother.
- Uterine rupture: This occurs when there is a tear through the layers of the womb. A ruptured uterus can cause severe hemorrhaging in the mother, and the baby may even spill into the mother’s abdomen. The hemorrhaging can cause the mother to lose so much blood that there is a decreased flow of blood to the baby, or the rupture may be at a spot that affects the blood circulation between the uterus and placenta.
- Oligohydramnios: This is a pregnancy complication characterized by low levels of amniotic fluid. Oligohydramnios puts the baby at a significant risk of having a prolapsed or compressed umbilical cord, which cuts off oxygen supply. Oligohydramnios can also lead to meconium aspiration, which occurs when the baby inhales a mixture of amniotic fluid and stool into the lungs. This can cause respiratory distress and oxygenation problems with resultant brain damage.
- Premature rupture of the membranes (PROM) and premature birth: PROM occurs when the water breaks before the mother goes into labor. PROM can cause umbilical cord compression or premature birth, which can cause a baby to become oxygen deprived because the lungs are not yet fully developed. PROM also increases the risk of the baby getting an infection, which can lead to sepsis and meningitis with permanent neonatal brain damage.
- Prolonged and arrested labor: Contractions during labor are traumatic for the baby, and when labor is prolonged, oxygen flow to the baby’s brain can dimish severely. The labor-enhancing drugs Pitocin or Cytotec can exacerbate the oxygen deprivation.
- Placenta previa: This is when the placenta grows close to the opening of the uterus, which can partially or completely block the mother’s cervix (the opening to the birth canal). If the placenta remains close to or completely covers the cervix later in pregnancy, delivery by C-section is generally required because cervical opening and uterine activity during vaginal delivery can cause severe bleeding in the mother and even in the baby.
- Anesthesia mistakes can cause blood pressure problems and a hypotensive crisis in the mother. When a mother’s blood pressure drops too low, there will be a decreased supply of oxygen-rich blood going to the baby.
- Fetal stroke: This is when blood vessels in the brain become blocked or restricted. Forceps and vacuum extractors can cause the baby to have a stroke, which can cause severe oxygen deprivation. Hypoxic-ischemic encephalopathy (HIE) and stroke often occur together.
- Abnormal presentations: When babies are not in the normal, head first position at the time of delivery, they are at risk of suffering head trauma, brain bleeds, and umbilical cord problems if the physician attempts vaginal delivery. Breech presentation, transverse lie position, and face presentation are some of the abnormal fetal presentations that increase a baby’s risk of suffering bleeds and cord problems.
- Preeclampsia and eclampsia: Preeclampsia is a pregnancy condition in which the mother has high blood pressure diagnosed during pregnancy. When this occurs, there can be decreased blood flow to the baby. There are a number of ways high blood pressure can cause this. One way is that the high blood pressure and factors associated with it cause damage to or constriction of the vessels in the placenta. Preeclampsia also increases the risk of placental abruption. In addition, preeclampsia (or any long term pregnancy condition that can cause a baby to be deprived of oxygen) predisposes a baby to hypoxia during the stresses of labor.
Legal Help for Newborn Brain Injuries
The birth trauma team at Reiter & Walsh ABC Law Centers is here to help you understand the causes of your loved one’s birth injuries. Because our team of birth injury attorneys, nurses, and professionals works exclusively in the realm of birth trauma litigation, we have the experience, skill, and knowledge to help families like yours secure the resources they need for long term well-being. Contact Reiter & Walsh, P.C. today for a free legal consultation. We will review your case and inform you of your legal options.
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- Ferriero DM. Neonatal brain injury. N Engl J Med 2004; 351:1985.
- Graham EM, Ruis KA, Hartman AL, et al. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008; 199:587.
- Cowan F, Rutherford M, Groenendaal F, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 2003; 361:736.