Infant Intracranial Hemorrhages (Brain Bleeds) and Birth Trauma
Intracranial hemorrhages (otherwise known as brain bleeds) are a type of traumatic birth injury that range from minor to extremely severe. Intracranial hemorrhages can be caused by medical negligence, including complications and mistakes that lead to oxygen deprivation, trauma during delivery, improper delivery techniques and the misuse of forceps and vacuum extractors, among other reasons. It is important to diagnose intracranial hemorrhages as soon as possible in order to provide the right type of treatments and to limit the extent of the damage.
What are intracranial hemorrhages (brain bleeds)?
Infant intracranial hemorrhages are birth injuries distinguished by bleeding within the skull or brain of a newborn baby. They are often caused by hypoxia (oxygen deprivation) or birth trauma (excessive or blunt force during labor and delivery). Extracranial hemorrhages are similar to intracranial hemorrhages, but the bleeding occurs just outside the baby’s skull. There are many different types of brain bleeds, classified by the nature and location of the injury.
Types of brain bleeds
- Hemorrhagic stroke: A hemorrhagic stroke occurs when a blood vessel ruptures, causing bleeding within the brain. This can cause certain brain cells to be deprived of oxygen and nutrients. Hemorrhagic strokes can also cause pressure build up, irritation, and swelling, and may ultimately lead to neonatal brain damage. There are two main types of hemorrhagic stroke (1):
- Intracerebral hemorrhage: Also known as a cerebral hemorrhage, this type of brain bleed is characterized by bleeding that originates from blood vessels within the brain.
- Subarachnoid hemorrhage: Subarachnoid hemorrhages are characterized by bleeding in the subarachnoid space, which is the area between the innermost of the two membranes that cover the brain.
- Intraventricular hemorrhage: Intraventricular hemorrhages occur when there is bleeding into the brain’s ventricular system, where cerebrospinal fluid is produced. It is a very serious type of intracranial bleeding and is usually seen in premature infants and infants with low birth weight. This is because blood vessels in the brain of premature infants are not fully developed, and are therefore weak (2). Oxygen deprivation and birth trauma can also contribute to intraventricular hemorrhages (3, 4).
- Subdural hemorrhage or subdural hematoma: Subdural hemorrhages occur when there is a rupture of one or more blood vessels in the subdural space, which is the area between the surface of the dura and the arachnoid membranes (5). These ruptures are usually caused by traumatic injuries, which can include birth trauma.
- Cephalohematoma (cephalhematoma): Cephalohematomas are brain bleeds characterized by bleeding that occurs between the skull and its covering as the result of ruptured vessels. Cephalohematomas manifest as a raised bump on the baby’s head. Cephalohematomas are often the result of forceps or vacuum extraction injuries. Cephalohematomas usually go away on their own, but should be carefully monitored by medical professionals. Sometimes babies require treatment for associated complications such as anemia and jaundice (6).
Causes of intracranial hemorrhages (brain bleeds)
There are several complications, injuries, and medical mistakes that can cause perinatal brain bleeds. Common risk factors for and causes of intracranial hemorrhages in babies include:
- Macrosomia: This is a pregnancy condition in which the fetus is larger than average for the gestational age, which can make vaginal birth dangerous.
- Cephalopelvic disproportion (CPD): CPD is a similar problem to macrosomia, except that it specifically refers to a size mismatch between the fetal head and the mother’s pelvis (the head is unusually big and/or the pelvis is unusually small).
- Abnormal fetal presentation, such as a fetus in the breech, face, or brow presentation
- Trauma from prolonged labor
- Abnormal changes in blood pressure
- Blood disorders, such as vitamin K deficiency or hemophilia
- Hypoxic-ischemic encephalopathy (HIE): Hypoxic-ischemic encephalopathy is a dangerous neonatal brain injury resulting from decreased oxygen and blood flow to the baby at or near the time of delivery. The lack of blood flow results in cell death and causes the blood vessel walls to break down, leading to bleeding.
If risk factors for intracranial hemorrhage are present, the physicians and nurses must closely monitor the baby for signs of fetal distress and give the mother the option for a C-section. If fetal distress occurs and normal methods of delivery are unsuccessful, an emergency C-section is required to minimize the risk of intracranial hemorrhage, as well as other birth injuries.
Unfortunately, severe head and brain trauma to newborns can also occur from medical intervention during labor and delivery. For example:
- Forceps and vacuum extractors: Improper use of delivery instruments such as forceps or vacuum extractors is well-documented as a cause of intracranial bleeding.
- Delivery techniques: Improper delivery technique (for instance, excessive twisting or pulling of the infant’s head) and traumatic breech delivery can cause severe intracranial hemorrhages.
Additionally, premature babies are at a much higher risk for intracranial hemorrhages due to the fragility of their underdeveloped blood vessels. Therefore, it is very important for medical professionals to do all they safely can to prevent premature birth and delivery atraumatically when delivering a premature baby.
Signs and symptoms of intracranial hemorrhages (brain bleeds)
Symptoms of intracranial hemorrhages in infants will vary based on the type and severity of the bleed, but include the following:
- Neonatal seizures
- Feeding difficulties
- Bulging fontanelle/soft spot
- Shallow or strained breathing
- Abnormal tone
- Altered level of consciousness
If medical professionals detect signs of an intracranial hemorrhage or suspect that an intracranial hemorrhage occurred, brain imaging studies are performed to confirm the presence of blood within the skull. The best methods of detecting a brain bleed are MRIs and CT scans. MRI (magnetic resonance imaging) uses magnetic waves to generate pictures of the brain. CT scans (computed tomography) use computer software and x-rays to create pictures of structures inside the baby’s brain. Occasionally, ultrasonography and testing of cerebrospinal fluid is performed.
For more information on the process of diagnosing intracranial hemorrhages, please visit this page.
Treating infant intracranial hemorrhages (brain bleeds)
Treatment of intracranial bleeds is mostly of a supportive nature, although neurosurgical intervention may be necessary to manage certain types. The prognosis varies depending on the severity and location of the bleed. Some infants do very well with little or no residual effects. More severe bleeds can result in mental and physical impairments such as developmental delays, learning disabilities, and cerebral palsy (CP). Diagnosing an intracranial hemorrhage is crucial—the earlier a baby is diagnosed with an intracranial hemorrhage, the earlier treatment and therapy can begin.
For more information on treatments for intracranial hemorrhages, please visit this page.
How do you pronounce intracranial hemorrhage?
Trusted birth trauma attorneys representing intracranial hemorrhage victims
Pursuing legal help for an intracranial hemorrhage is one of the first steps you can take to secure a better life for your birth-injured baby. Obtaining compensation from a successful medical malpractice case will better allow your family to afford treatment, therapy, lifestyle adjustment, adaptive equipment, life care, and more.
At Reiter & Walsh ABC Law Centers, our team of attorneys, nurses, and other professionals exclusively focus on birth injury cases. Our narrow focus allows us to take on the most complex cases and build litigation experience in a wide array of complications, medical errors, and injuries.
During your free legal consultation, our attorneys will discuss your case with you, determine if negligence caused your baby’s injuries, identify the negligent party, and discuss your legal options with you.
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Birth injury, birth trauma and intracranial hemorrhages
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- Hemorrhagic Stroke. (n.d.). Retrieved December 7, 2018, from https://www.stlouischildrens.org/conditions-treatments/hemorrhagic-stroke
- Children’s Hospital. (2014, August 24). Intraventricular Hemorrhage. Retrieved December 7, 2018, from https://www.chop.edu/conditions-diseases/intraventricular-hemorrhage
- Al Yazidi, G., Srour, M., & Wintermark, P. (2014). Risk factors for intraventricular hemorrhage in term asphyxiated newborns treated with hypothermia. Pediatric neurology, 50(6), 630-635.
- Ballabh, P. (2010). Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatric research, 67(1), 1.
- (n.d.). Retrieved December 7, 2018, from https://www.uptodate.com/contents/intracranial-subdural-hematoma-in-children-clinical-features-evaluation-and-management
- Healthline. (2017, June 5). Cephalohematoma (CH): Causes, Outlook, and More. Retrieved December 7, 2018, from https://www.healthline.com/health/cephalohematoma#complications