Infant Intracranial Hemorrhages (Brain Bleeds) and Birth Trauma

Intracranial hemorrhages (otherwise known as brain bleeds) are birth injuries that range from minor to extremely severe. They can be caused by birth asphyxia (oxygen deprivation during or around the time of birth) or birth trauma (injuries caused by excessive mechanical force to the baby’s head). In many cases, these complications stem from medical negligence. For example, doctors may misuse tools such as forceps and vacuum extractors. It is imperative 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 (1).

Infant Brain Bleeds and Hemorrhages

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Types of brain bleeds

There are many different types of brain bleeds, including intracranial (inside of the brain) and extracranial (outside of the brain) bleeds. Intracranial Hemorrhages
    • 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 buildup, irritation, and swelling, and may ultimately lead to neonatal brain damage. There are two main types of hemorrhagic stroke (2):
      • Intracerebral hemorrhage: Also known as 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.
Subarachnoid Hemorrhage, Infant Intracranial Hemorrhages, Brain BleedsLateral Ventricles | Neonatal 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 weaker than that of term babies (3). Oxygen deprivation and birth trauma can also contribute to intraventricular hemorrhage (4, 5).
  • 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 (6). These ruptures are usually caused by traumatic injuries, which can include birth trauma.
Extracranial Hemorrhages
  • Caput succedaneum: A swelling of the scalp, which can be hemorrhagic. It extends across the suture lines, and usually happens because the baby has had vacuum extraction or has been in the birth canal for a prolonged period (7).
  • 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 (8).
  • Subgaleal hematoma: An SGH occurs when blood accumulates in the area between aponeurosis and the periosteum (the skull and the scalp) where there is loose areolar tissue (7).

Risk factors of intracranial hemorrhages

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, medical professionals 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 and other birth injuries.Medical intervention causes of intracranial hemorrhagesUnfortunately, 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 deliver a premature baby safely.

Signs and symptoms of intracranial hemorrhages

Symptoms of intracranial hemorrhages in infants will vary based on the type and severity of the bleed, but include the following:

Diagnosing intracranial hemorrhages Fetal brain hemorrhage, intracranial hemorrhage, neonatal brain damage

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 (computed tomography) scans 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

Treatment of brain 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.

Long-term effects of intracranial hemorrhages

Intracranial hemorrhages have been found to have long-term cognitive and behavioral effects. One study found that, when evaluated at age 8, with neurologic assessments, a battery of behavioral, academic, and cognitive assessments, and a history of school performance, the children who experienced intraventricular hemorrhage (IVH) as infants had more of these issues than those that didn’t have hemorrhages as infants (9). The children who had IVH had higher rates of hearing impairment and cerebral palsy, and had lower rates of IQ, daily living skills, and test scores in reading and math.The long-term outcomes of infant brain bleeds depend on the severity of the bleed as well as its treatment and management.

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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Related reading

Reiter & Walsh ABC Law Centers
Birth injury, birth trauma and intracranial hemorrhages

Sources

  1. Naidech A. M. (2011). Intracranial hemorrhage. American journal of respiratory and critical care medicine, 184(9), 998–1006. doi:10.1164/rccm.201103-0475CI
  2. Hemorrhagic Stroke. (n.d.). Retrieved December 7, 2018, from https://www.stlouischildrens.org/conditions-treatments/hemorrhagic-stroke
  3. Children’s Hospital. (2014, August 24). Intraventricular Hemorrhage. Retrieved December 7, 2018, from https://www.chop.edu/conditions-diseases/intraventricular-hemorrhage
  4. 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.
  5. Ballabh, P. (2010). Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatric research, 67(1), 1.
  6. (n.d.). Retrieved December 7, 2018, from https://www.uptodate.com/contents/intracranial-subdural-hematoma-in-children-clinical-features-evaluation-and-management
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  8. Healthline. (2017, June 5). Cephalohematoma (CH): Causes, Outlook, and More. Retrieved December 7, 2018, from https://www.healthline.com/health/cephalohematoma#complications
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