What are the causes of newborn brain injuries?

The causes of infant 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 brain near the time of birth (birth asphyxia).

Brain bleeds (intracranial hemorrhages) are an example of a traumatic brain injury caused by excessive force to the baby’s brain or skull. Brain bleeds can be caused by misuse of forceps or vacuum extractors, abnormal fetal presentation, prolonged labor, and other complications that increase the risk of head injury. The risk of intracranial hemorrhage is also higher in infants who have experienced birth asphyxia and hypoxic-ischemic encephalopathy (HIE) (1, 2).

HIE is a dangerous type of neonatal brain injury 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). In addition to birth trauma, HIE can be caused by complications that impact blood flow through the umbilical cord, placenta, and uterus (womb) (3).

If physicians pay close attention to the baby’s heart rate on the fetal heart monitor, and if they follow other standards of care, birth injuries and infant brain damage can often be prevented. The key is to quickly deliver the baby as soon as signs of fetal distress (oxygen deprivation) are evident. An emergency C-section is usually the fastest and safest way to deliver a baby who is in distress.


Causes of infant brain damage

Listed below are some complications and injuries that, if not properly managed, can cause brain damage in a baby.

  • Forceps and vacuum extractor injuries: Forceps and vacuum extractors are tools that can help guide a baby out of the birth canal. Forceps resemble salad tongs, and are applied to each side of the baby’s head. A vacuum extractor is a small cup that is placed on the baby’s head so the physician can apply gentle traction. These tools must only be used by highly-trained staff and only under very specific circumstances. Improper use of forceps and vacuum extractors can cause traumatic birth injuries, brain bleeds, strokes, and serious brain damage (4).
  • Infection: An infection in the mother can travel to the baby during the birthing process. However, this can often be prevented by administering antibiotics, ensuring that vaginal delivery is not prolonged (it is important to minimize the time period during which infections can travel), or performing a C-section. Medical professionals must also take care to ensure that babies do not become infected shortly after birth, and to promptly treat any infections that arise. Newborn infections can become serious very quickly, and may result in permanent brain damage if improperly managed (5). These dangerous infections include chorioamnionitis, Group B strep (GBS), herpes simplex virus (HSV), Staphylococcus (staph), and E. coli.  The term “sepsis” refers to an infection in the baby’s bloodstream, and “meningitis” refers to infection of the brain and central nervous system.Birth
  • Umbilical cord problems: Any complication that causes the umbilical cord to become compressed – or otherwise interrupts the flow of blood through the umbilical cord – is a potential cause of neonatal brain injury. These issues include a prolapsed umbilical cord, the cord being wrapped around the baby’s neck (nuchal cord), a short umbilical cord, the cord being in a true knot, vasa previa, and chorioamnionitis (umbilical cord infection) (6). 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 (7).
  • 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 significant or complete placental abruption, the baby may not be able to receive any oxygen-rich blood from the mother (8).
  • 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 (9).
  • Oligohydramnios: This is a pregnancy complication characterized by low levels of amniotic fluid. Oligohydramnios puts the baby at a significant risk of having a compressed umbilical cord, which cuts off the 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 (10). This can cause respiratory distress and oxygenation problems with resultant brain damage (11).
  • Premature rupture of the membranes (PROM) and premature birth: PROM occurs when the water breaks (i.e. amniotic sac ruptures) before the mother goes into labor. PROM can cause umbilical cord prolapse and compression. It can also lead to premature birth, which can cause a baby to become oxygen deprived because the lungs are not yet fully developed. Moreover, PROM increases the risk of the baby getting an infection, which can lead to sepsis and meningitis with permanent neonatal brain damage (12).
  • Prolonged and arrested labor: Contractions during labor put the baby under stress from temporary oxygen deprivation, and when labor is prolonged, oxygen flow to the baby’s brain can diminish severely. The labor-enhancing drugs Pitocin and Cytotec can exacerbate the oxygen deprivation when used improperly (13).
  • Placenta previa: This is when the placenta grows unusually low in the uterus, partially or completely blocking 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 the subsequent cervical opening and uterine activity during vaginal delivery can cause severe bleeding in the mother and even in the baby (14).
  • Anesthesia mistakes: Errors in anesthesia administration 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 (15).
  • Fetal stroke: This is when blood vessels in an unborn baby’s 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 (16).
  • Abnormal presentations: When babies are not in the normal, head-first presentation (vertex) at the time of delivery, they are at risk of suffering head trauma, brain bleeds, and umbilical cord problems if the physician attempts a vaginal delivery. Breech presentation, transverse lie, and face presentation are some of the abnormal fetal presentations that increase a baby’s risk of sustaining brain damage (17).
  • 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 (18).

The importance of prompt diagnosis and treatment for neonatal brain damage

It is critical that doctors quickly recognize and treat infant brain damage. If a newborn is showing signs and symptoms of brain damage, they should order tests such as magnetic resonance imaging (MRI) and computed tomography (CT scans). 

If there is a brain injury, the healthcare providers must act quickly to minimize lasting damage. For newborns with hypoxic-ischemic encephalopathy (HIE), they must promptly provide therapeutic hypothermia. This treatment can slow the spread of injured brain cells and reduce the likelihood/extent of permanent disabilities. If the medical team fails to provide this treatment, and the baby sustains more severe brain damage as a result, this is medical malpractice.


Legal help for brain injuries in babies

ABC Law Centers was established to focus exclusively on birth injury and neonatal brain damage cases. We have obtained multi-million dollar settlements and verdicts for clients with hypoxic-ischemic encephalopathy (HIE), cerebral palsy (CP), and other developmental delays and disabilities. Our awards and testimonials further attest to our success.

If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win!

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Sources

  1. Traumatic Birth Injuries. (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/types-of-birth-injuries/birth-trauma/
  2. Bashir, R. A., Vayalthrikkovil, S., Espinoza, L., Irvine, L., Scott, J., & Mohammad, K. (2018). Prevalence and Characteristics of Intracranial Hemorrhages in Neonates with Hypoxic Ischemic Encephalopathy. American journal of perinatology, 35(07), 676-681.
  3. Hypoxic-Ischemic Encephalopathy (HIE). (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/fetus-or-newborn-medical-problems/hypoxic-ischemic-encephalopathy/
  4. Forceps and Vacuum Extractor Injuries. (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/traumatic-birth-injuries/forceps-and-vacuum-extractor-injuries/
  5. Infections in Newborns. (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/neonatal-birth-injuries/infection/
  6. Umbilical Cord Problems. (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/umbilical-cord-problems/
  7. Fetal Life-Support System: Placenta and Umbilical Cord. (2019, September 16). Retrieved October 17, 2019, from https://americanpregnancy.org/while-pregnant/fetal-life-support-system/
  8. Placental Abruption. (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/labor-and-delivery-complications-and-errors/placental-abruption/
  9. Uterine Rupture and Birth Injuries. (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/labor-and-delivery-complications-and-errors/uterine-rupture-and-hie/
  10. Oligohydramnios (Low Amniotic Fluid) (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/maternal-medical-conditions/oligohydramnios/
  11. Meconium Aspiration Syndrome (MAS) and Birth Injury (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/neonatal-birth-injuries/meconium-aspiration-syndrome/
  12. Premature Rupture of Membranes (PROM) and Birth Injury (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/maternal-medical-conditions/premature-rupture-of-membranes/ 
  13. Prolonged Labor, Arrested Labor, and Birth Injury (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/traumatic-birth-injuries/prolonged-and-arrested-labor/
  14. Placenta Previa and Birth Injury (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/labor-and-delivery-complications-and-errors/placenta-previa/
  15. Anesthesia Errors and Birth Injuries (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/labor-and-delivery-medication-errors/anesthesia-mistakes/
  16. Perinatal Stroke (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/types-of-birth-injuries/cerebral-palsy/cerebral-palsy-caused-by-stroke/
  17. Abnormal Fetal Position and Presentation (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/abnormal-position-or-presentation/
  18. Mismanaged Preeclampsia During Pregnancy (n.d.). Retrieved October 17, 2019, from https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/maternal-medical-conditions/preeclampsia-and-eclampsia/