Microcephaly (Small Head) and Birth Injuries
A diagnosis of microcephaly (small head) in a baby can be an indication that the baby suffered hypoxic-ischemic encephalopathy (brain damage caused by limited oxygen at or around the time of birth), and it also makes it more likely that the baby will have cerebral palsy.
What Is Microcephaly?
Problems with normal head growth may be the first indication that a baby has a neurological problem. Microcephaly is a neurodevelopmental disorder, meaning the small head size is caused by a problem with the brain/central nervous system. Causes of microcephaly include hypoxic-ischemic encephalopathy (HIE), ischemic stroke, stroke caused by a brain bleed (hemorrhagic stroke), maternal infection, poorly-controlled gestational diabetes, placental insufficiency, a traumatic brain injury caused by forceps or vacuum extractors, encephalitis and meningitis (brain infections in the baby). These conditions can also cause the baby to have cerebral palsy.
Microcephaly, also called microencephaly, is usually defined as a head circumference more than 2 standard deviations below the mean for the baby’s age and gender. Microcephaly may be present at or near the time of birth, or it may develop in the first few years of life. Sadly, the life expectancy for children with microcephaly is reduced, and the prognosis for normal brain function is poor. Due to the poor outlook, it is crucial for the medical team to prevent or quickly rectify conditions that can cause microcephaly. Often, microcephaly is caused by a birth injury, which is when the baby gets injured during or near the time of birth.
How Do You Pronounce Microcephaly?
Causes of Microcephaly
Listed below are some of the complications during or near the time of birth that can cause microcephaly if not properly managed.
Hypoxic-ischemic encephalopathy (HIE). HIE is a brain injury caused by a lack of oxygen to the baby’s brain. This oxygen deprivation can be caused by a lack of oxygen in the baby’s blood and/or a restriction of blood flow in the baby’s brain. Anything that causes the baby to experience a reduction of oxygen-rich blood in her brain can cause HIE. Conditions that can cause oxygen deprivation in a baby include problems that occur when the baby is in the womb, such as placental abruption, a ruptured uterus (womb), the umbilical cord being wrapped around the baby’s neck, and umbilical cord prolapse.
If a baby experienced a traumatic delivery or the mother had some problems with the pregnancy, physicians should assess the baby for symptoms of HIE right after birth. If a baby has HIE and receives hypothermia treatment within 6 hours of the HIE-causing insult, the brain injury is likely to be less severe and there is a reduced risk of the baby developing cerebral palsy. Hypothermia (brain cooling) treatment cools a baby’s core body temperature and it slows down almost every damaging process that starts to occur when the brain is deprived of oxygen.
Hemorrhagic stroke. This is when a blood vessel in or near the brain ruptures, causing bleeding in the brain. Labor and delivery is a common time when strokes can occur in newborns, and hemorrhagic strokes are often caused by the use of forceps or vacuum extractors during delivery. These risky instruments are used to assist with vaginal delivery. Forceps and vacuum extractors should only be used by physicians skilled in their use, and standards of care must be followed at all times due to the high risk of harm to the baby’s head and the potential for brain bleeds and strokes.
Forceps look like salad tongs and are applied to each side of the baby’s head. The physician is supposed to make sure certain conditions are met prior to the use of forceps, and the forceps must be precisely placed on the head. It also is imperative that the physician not apply too much force to the baby’s delicate head.
A vacuum extractor is a soft cup that is placed on the baby’s head so the physician can apply gentle traction to help ease the baby out of the birth canal. Just like forceps, very specific criteria must be met before a physician uses a vacuum extractor, and standards of care must be followed. Vacuum extractors are more commonly used than forceps, and they place a baby at an even greater risk of suffering a brain bleed. In particular, the pressure of the suction cup can cause a type of extracranial hemorrhage (bleed) called a subgaleal hemorrhage. This occurs when the vacuum ruptures a vein and then the vein bleeds into the space between the scalp and the skull. This is life-threatening for the baby and can cause 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.
Ischemic stroke. An ischemic stroke occurs when the blood flow to the baby’s brain is diminished, usually because of a clot, in one of the blood vessels in the brain. Use of vacuum extractors during delivery puts a baby at risk for suffering an ischemic stroke, which is why this delivery instrument should only be used in certain circumstances, standards of care must be precisely followed, and the baby should be very closely monitored during vacuum extraction delivery.
Strokes are one of the most common causes of cerebral palsy in term and near-term infants. Strokes that occur during or near the time of birth are often missed until the baby is 3 – 4 months old and hemiplegia is apparent in the baby. Hemiplegia is paralysis of the arm, leg, and trunk on the same side of the body.
Traumatic brain injury caused by forceps and vacuum extractors. As discussed above, forceps and vacuum extractors are very risky delivery instruments that should only be used in very limited circumstances. They put a baby at an increased risk of experiencing head trauma and intracranial hemorrhages (brain bleeds).
Maternal infection, sepsis, and meningitis. Certain infections in a pregnant woman can be passed on to the baby at birth, which is why it is crucial for physicians to recognize and properly treat infections in mother. These infections include Group B streptococcus (GBS), chorioamnionitis, herpes simplex virus (HSV), E coli, and Staphylococcus (staph) infections.
When these infections are passed on to the baby, the baby can get a very serious infection in her bloodstream called sepsis. Sepsis can damage the brain either by direct infection of the central nervous system or by causing inflammation in the brain (encephalitis). Sepsis often causes meningitis, which is inflammation of the membranes around the brain and spinal cord. The most common source of meningitis is GBS. Sepsis can also cause the baby to go into septic shock, which causes a severe reduction in blood flow and blood pressure. When the blood pressure gets really low, the baby’s brain can become deprived of oxygen, which can cause permanent brain damage.
Gestational diabetes. This is when a woman is diagnosed with diabetes for the first time during pregnancy. Gestational diabetes is one of the most common medical conditions that occur during pregnancy, affecting 18% of all pregnant women. It usually begins midway through pregnancy and occurs when the body cannot make and use as much insulin as it needs. Insulin is used to convert glucose (blood sugar) into energy.
Babies born to mothers who have gestational diabetes – especially poorly-managed diabetes – are likely to be macrosomic (large for gestational age), which puts them at risk for a number of health problems, and it also increases babies’ chances of experiencing a traumatic birth. In addition, at birth, these babies are left with ongoing high insulin production and susceptibility to hypoglycemia (low blood sugar levels). Hypoglycemia can lead to brain damage if not promptly recognized and properly treated.
Placental insufficiency. Blood is brought to (and returned from) the unborn baby through the placenta. The placenta allows for nutrients to be transported to the baby, and it is also where gas exchange takes place. Carbon dioxide is removed from the baby’s blood here, and the baby gets oxygen from the mother through the placenta. When there is placental insufficiency, there is a lack of adequate blood flow to the baby, which can cause the baby to be deprived of nutrients and oxygen. When this occurs, the baby’s brain can suffer permanent damage. Conditions associated with placental insufficiency include oligohydramnios and preeclampsia. Placental insufficiency is the most frequent cause of intrauterine growth restriction (IUGR), wherein the baby is small for gestational age.
A diagnosis of placental insufficiency can be made if, during pregnancy, the baby has an abnormal heart tracing called “late decelerations” on the fetal heart rate monitor. Late decelerations are an indication of placental insufficiency, even when there are no other signs of reduced blood flow to the placenta.
Due to the severe consequences of placental insufficiency, it is crucial for physicians to promptly diagnose and adequately manage this condition. Mothers with placental insufficiency should be referred to maternal-fetal specialists. Very close fetal monitoring, including frequent non-stress tests and biophysical profiles, should be performed. Sometimes the physician will decide to deliver the baby early by cesarean (C-section) delivery.
Microcephaly Attorneys Representing Victims of Medical Malpractice
The conditions listed above are some of the many complications that can cause microcephaly as well as cerebral palsy. It is very important for physicians to closely monitor a mother during pregnancy and recognize complications that can cause permanent brain injury in a baby, such as cerebral palsy. Medical conditions must be properly managed throughout pregnancy and delivery. During labor and delivery, the baby’s heart rate should be closely monitored so that if distress occurs, they can be promptly delivered and treated. Standards of care must be closely followed to decrease the chance that the baby will suffer a brain bleed, stroke or hypoxic-ischemic encephalopathy (HIE) during delivery.
HIE is frequently caused by a delayed C-section delivery when fetal distress is evident on the heart rate monitor. When there are problems with the baby’s umbilical cord, placental abruption or uterine rupture occur, or the baby is experiencing a brain bleed, distress will almost always be evident on the fetal heart rate monitor. These conditions can cause a severe lack of oxygen in the baby’s brain, which is why quick delivery and treatment must occur when a baby experiences them.
When you need the help of a birth injury lawyer, it is very important to choose a lawyer and firm that focuses only on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children for over 25 years. Cerebral palsy lawyer Jesse Reiter, president of the firm, has been focusing solely on birth injury cases for 25 years, and most of his cases involve hypoxic-ischemic encephalopathy (HIE) and cerebral palsy. Jesse is currently recognized as one of the best medical malpractice lawyers in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a permanent disability, such as cerebral palsy, a seizure disorder, hypoxic-ischemic encephalopathy (HIE) or periventricular leukomalacia (PVL), the attorneys 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 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 lawyers are available 24/7 to speak with you.
Video: Microcephaly Attorneys Discuss Birth Asphyxia
Watch a video of microcephaly attorneys Jesse Reiter & Rebecca Walsh discussing how birth injuries such as microcephaly and cerebral palsy are often caused by a lack of oxygen to the baby’s brain during or near the time of birth, called birth asphyxia.
Nard JA. Abnormal head size and shape. In: Common & Chronic Symptoms in Pediatrics, Gartner JC, Zitelli BJ (Eds), Mosby, St. Louis 1997.
Rios A. Microcephaly. Pediatr Rev 1996; 17:386.
Abuelo D. Microcephaly syndromes. Semin Pediatr Neurol 2007; 14:118.
Leroy JG, Frías JL. Nonsyndromic microcephaly: an overview. Adv Pediatr 2005; 52:261.
Opitz JM, Holt MC. Microcephaly: general considerations and aids to nosology. J Craniofac Genet Dev Biol 1990; 10:175.
Ashwal S, Michelson D, Plawner L, et al. Practice parameter: Evaluation of the child with microcephaly (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2009; 73:887.
Deloison B, Chalouhi GE, Bernard JP, et al. Outcomes of fetuses with small head circumference on second-trimester ultrasonography. Prenat Diagn 2012; 32:869.
Rosman NP, Tarquinio DC, Datseris M, et al. Postnatal-onset microcephaly: pathogenesis, patterns of growth, and prediction of outcome. Pediatrics 2011; 127:665.