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 (brain bleeds) are hypoxic or traumatic birth injuries distinguished by abrupt, rapid bleeding within the skull or brain of a newborn baby. Extracranial hemorrhages are similar to intracranial hemorrhages, but the bleeding occurs just outside the baby’s skull. There are several different types of brain bleeds, depending on the nature and location of the injury.
- Cerebral hemorrhage: Cerebral hemorrhages are a type of stroke in which a ruptured blood vessel causes bleeding within the baby’s brain itself.
- 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. This type of intracranial hemorrhage, which is the second most frequently detected brain bleed in babies, usually occurs in full term babies and produces seizure activity, lethargy, and apnea. Subarachnoid hemorrhages can also lead to hydrocephalus, periventricular leukomalacia (PVL), cerebral palsy, and permanent brain damage.
- Intraventricular hemorrhage: Intraventricular hemorrhages occur when there is bleeding into the brain’s ventricular system, where spinal fluid is produced. It is the most 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. Intraventricular hemorrhages can also result from physical trauma during birth and hypoxia (oxygen deprivation within the baby’s brain).
- Subdural hemorrhage or subdural hematoma: Subdural hemorrhages are the most common type of infant intracranial hemorrhage. 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 brain and the thin layer of tissue that separates the brain from the skull. These ruptures are usually caused by difficult deliveries. Seizures, high levels of bilirubin in the blood, a rapidly-enlarging head, a poor Moro reflex, or extensive retinal hemorrhages (bleeding of the vessels in the retina) sometimes occur with these kinds of hemorrhages.
- Cephalohematoma (cephalhematoma): Cephalhematomas are brain bleeds characterized by bleeding that occurs between the skull and its covering as the result of ruptured vessels. Cephalohematomas begin as a raised bump on the baby’s head, typically occurring a few hours after birth and lasting anywhere from two weeks to a few months. While they can be the result of any kind of trauma inflicted on the baby’s head, cephalohematomas are most commonly the result of forceps or vacuum extraction deliveries. Untreated cephalohematoma can lead to severe neonatal infection, cell death within the brain, and/or calcification of the hematoma.
Causes of Intracranial Hemorrhages (Brain Bleeds)
There are several complications, injuries and medical mistakes that can cause brain bleeds during labor and delivery. While there is overlap, different types of intracranial hemorrhages have different causes and risk factors. Some of the most common causes of intracranial hemorrhages in babies include the following:
- Macrosomia: This is a pregnancy condition in which the fetus is larger than average for the gestational age.
- Cephalopelvic disproportion (CPD): This pregnancy condition occurs when the fetus is too large to fit through the mother’s pelvis easily.
- 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.
In cases like these, 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 does occur 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) can cause severe brain bleeds and hemorrhages.
Additionally, premature babies are at a higher risk for intracranial hemorrhages due to the fragility of their underdeveloped blood vessels. Approximately 20% of premature infants weighing under about 3.3 pounds suffer intracranial hemorrhages.
Signs and Symptoms of Intracranial Hemorrhages (Brain Bleeds)
Symptoms of intracranial hemorrhages will vary based on the type and severity of the bleed. Infants with intracranial hemorrhages and brain bleeds may exhibit the following signs and symptoms:
- Neonatal seizures
- Feeding difficulties
- Bulging fontanelle/soft spot (intraventricular hemorrhage)
- Shallow or strained breathing
- Altered 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 cerebral spinal fluid is performed.
For more information on the process of diagnosing intracranial hemorrhages, please visit this page.
Treatment of Intracranial Hemorrhages (Brain Bleeds)
Treatment of intracranial bleeds is mostly of a supportive nature, although neurosurgical intervention may be necessary to manage subdural hematomas. 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. 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.
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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 loved one. 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 birth trauma attorneys, nurses and professionals exclusively focus on birth injury cases. Our narrow focus allows our team to take on the most complex birth injury cases and build litigation experience in a wide array of complications, medical errors and injuries. We handle cases all over the country, in states such as Michigan, Ohio, Pennsylvania, Texas, Tennessee, Wisconsin, Arkansas, Mississippi, Washington D.C., and more. During your free legal consultation, our birth injury attorneys will discuss your case with you, determine in negligence caused your loved one’s injuries, identify the negligent party, and discuss your legal options with you.
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