Neonatal Encephalopathy Caused By a Nuchal Cord (Cord Wrapped Around Baby’s Neck)

In a nuchal cord, the umbilical cord is wrapped around the baby’s neck. This can cause a severe lack of oxygen to the brain (birth asphyxia). During labor and delivery, it is the standard of care to continuously monitor the baby’s heart rate. The medical team must pay close attention to the heart rate monitor for signs of birth asphyxia. If a nuchal cord is serious enough to cause birth asphyxia, the fetal heart monitor will show nonreassuring heart tracings. Once these tracings begin, the physician must deliver the baby, often by C-section, which is often the fastest and safest way to deliver a baby in distress. If birth asphyxia is prolonged, the baby can develop neonatal encephalopathy (NE), which can cause brain damage, cerebral palsy, seizures, intellectual disabilities and developmental delays. Hypoxic ischemic encephalopathy (HIE) is the most common type of neonatal encephalopathy. Nuchal cords are detected via ultrasound imaging. Sometimes, nuchal cords can cause decreased fetal movement after 37 weeks.

If your child had a nuchal cord and now has seizures, neonatal encephalopathy, HIE, cerebral palsy or any other long-term condition, contact Reiter & Walsh today at 888-419-2229. Our award winning birth injury lawyers are available 24/7 to speak with you.


How Does the Cord Being Wrapped Around the Baby’s Neck (Nuchal Cord) Cause Birth Asphyxia and Neonatal Encephalopathy?

The umbilical cord carries the baby’s sole source of oxygen to her in the womb. Oxygen-rich blood travels from the mother through the placenta and then into the baby via the umbilical cord. Anything that hinders the flow of blood through the umbilical cord can cause the baby to experience birth asphyxia. A nuchal cord can be type A, which is when the cord is looped around the fetal neck in a way that may be undone with movement, or type B, which is when the cord ends up in a true knot.

When the cord is wrapped around the baby’s neck, either in a type A or type B true knot pattern, the baby can be deprived of oxygen by the following mechanisms:

  1. The cord is compressed, which means the vessels in the cord are impinged upon or occluded, thereby halting the flow of blood to the baby;
  2. The cord is so tight it restricts flow in major blood vessels in the baby’s neck;
  3. The nuchal cord causes venous blood to be congested, or backed up, which decreases circulation in the baby.

What Happens When Medical Professionals Detect a Nuchal Cord?

Nuchal cords are very common. The can form at any time, disentangle and reform. During prenatal testing, a nuchal loop may be recognized with an ultrasound or it may be suspected if the baby is showing signs of distress during a nonstress test or biophysical profile. During labor and delivery, the fetal heart rate monitor will pick of oxygen deprivation in the baby, which manifests as nonreassuring heart tracings. Once these tracings occur, the baby should be promptly delivered, usually by emergency C-section. Sometimes during delivery, the physician will try to slip the cord over the baby’s head to decrease compression while attempting to deliver the shoulders or body. Or the physician may try to use a technique that involves slipping the cord over the baby’s shoulders or another maneuver that allows the baby to be born in a somersault. Whatever the approach, the medical team should start making preparations for an emergency C-section in case the baby cannot be quickly and safely delivered via the vaginal route. A nuchal cord is an obstetrical emergency that requires close monitoring of the baby’s heart rate and prompt delivery at the first signs of distress.


Failure to Diagnose Nuchal Cord

Failure to recognize birth asphyxia and nonreassuring heart tracings during prenatal testing or labor and delivery is negligence. Failure to quickly deliver a baby who is experiencing birth asphyxia is also negligence. If this negligence causes permanent injury in the baby, it is medical malpractice. Birth asphyxia often causes neonatal encephalopathy and hypoxic-ischemic encephalopathy, which can cause permanent brain damage and cerebral palsy.

nuchal cord; cord around the neck; umbilical cord; fetal hypoxia; hypoxic ischemic encephalopathy, HIE; birth asphyxia; neonatal encephalopathy, intrapartum asphyxia; fetal oxygen deprivation


What is Neonatal Encephalopathy (NE)?

Neonatal encephalopathy is a broad term used to describe disturbed brain function in a newborn caused by an insult to the brain. Birth asphyxia, meningoencephalitis (encephalitis with meningitis), intracranial and extracranial hemorrhages (brain bleeds), stroke, and infection can all cause encephalopathy in babies. Hypoxic ischemic encephalopathy (HIE) is the most common type of NE. Neonatal encephalopathy occurs in babies born at or beyond 35 weeks of gestation, and the condition is manifested by seizures or a subnormal level of consciousness.

Neonatal encephalopathy means there are signs in the baby that indicate brain swelling caused by a brain injury. Signs and symptoms of NE may include the following:

  • Seizures
  • Low Apgar Scores
  • A weak or absent cry at delivery
  • An abnormal level of consciousness (hyperalert, irritable, lethargic, obtunded (not very alert)
  • Tone and reflex abnormalities, such as hypotonia (baby is limp or floppy) and hypertonia (baby is stiff or spastic)
  • Apnea (periods in which the baby stops breathing for 20 seconds or more)
  • Feeding difficulties
  • Respiratory problems (on a breathing machine)
  • Fever
  • If the baby has meningitis or meningoencephalitis, her neck may be stiff
  • Hypotension
  • Organ failure
  • Hyper or hypoglycemia

Neonatal encephalopathy can cause the following conditions:


What Does a Neonatal or Hypoxic-Ischemic Encephalopathy Diagnosis Mean For My Baby?

When parents are told their newborn has neonatal encephalopathy, they want to know if the condition can be treated and what the long term outlook is for their child. In many cases, the baby ends up with no permanent damage or long-term consequences, especially if the encephalopathy is the kind that can be treated with hypothermia (brain cooling) treatment.

Babies who have hypoxic ischemic encephalopathy (HIE) are eligible for hypothermia treatment, but it must be started within 6 hours of the insult, which usually means 6 hours after delivery. Hypothermia treatment has been shown to halt almost every injurious process that starts to occur when the baby experiences an oxygen depriving insult. The treatment can prevent a baby with hypoxic ischemic encephalopathy from developing cerebral palsy or the baby may have a less severe form of the condition.

Brain bleeds, infection and strokes commonly occur in cases of neonatal encephalopathy. If these conditions are promptly recognized and appropriately managed, the babies’ permanent disabilities may be limited. Of course, sometimes brain damage in a baby isn’t noticed until the child is 4 or 5 years old when certain developmental milestones are missed, which often occurs when a child has cerebral palsy.


Trusted Hypoxic-Ischemic Encephalopathy Attorneys

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 since 1997.

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 lawyers are available 24 / 7 to speak with you.


Video: Nuchal Cord


Sources:

  • Nelson KB, Grether JK. Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight. Am J Obstet Gynecol 1998; 179:507.
  • Verdel MJ, Exalto N. Tight nuchal coiling of the umbilical cord causing fetal death. J Clin Ultrasound 1994; 22:64.
  • Dhar KK, Ray SN, Dhall GI. Significance of nuchal cord. J Indian Med Assoc 1995; 93:451.
  • Collins JH. Nuchal cord type A and type B. Am J Obstet Gynecol 1997; 177:94.
  • Jauniaux, E., Ramsay, B., Peellaerts, C., & Scholler, Y. (2008). Perinatal features of pregnancies complicated by nuchal cord. American journal of perinatology, 12(04), 255-258.
  • Zahoor, Farnaz, Zakia Minhas, and Adil Zaki. “PERINATAL OUTCOME OF NUCHAL CORD.” Journal of Postgraduate Medical Institute (Peshawar-Pakistan) 27.2 (2013).