Neonatal Brain Damage & Long-Term Outcomes
Reiter & Walsh, P.C. | Trusted Infant Brain Injury Lawyers
Sometimes, infants sustain brain injuries around the time of birth or in the neonatal period (first month of life). Long-term prognosis depends on the severity of the injury as well as the timing and quality of treatment. Certain infants may make a good recovery, while others develop serious, permanent disabilities.
Many infant brain injuries occur when medical professionals deviate from accepted “standard of care.” Whenever a staff member or hospital fails to follow standard of care, this is negligence. If this negligence results in an infant brain injury or other type of harm, it constitutes medical malpractice.
Anatomy and function of a baby’s brain
The brain is a critically important and very complicated organ. It controls a multitude of functions, including thoughts, emotions, breathing, motor skills, vision, hunger, and much more.
Although the term “brain damage” makes many people think of intellectual disabilities, there are many other possible outcomes. For example, some brain-injured infants develop a motor disorder called cerebral palsy (CP), and/or other issues such as vision or hearing impairments, but are cognitively normal. Of course, individual children with brain injuries may have multiple disabilities.
The long-term impacts of a brain injury vary based on the severity of the injury, the treatment the infant receives, and of course the region of the brain that is affected. Although there are many different parts of the brain, the three major components include the cerebrum, the cerebellum, and the brainstem.
The cerebrum, or the front of the brain, is made up of right and left hemispheres. The hemispheres are joined by the corpus callosum. The cerebrum has many important functions, including:
- Initiation and coordination of movement
- Perception of touch, visual cues, and auditory stimuli
- Reasoning/problem solving
- Emotional responses
- Temperature control (1).
Although both hemispheres of the cerebrum overlap in the functions they control, research shows that the right side is used more for intuition and processing visual information, while the left side is used more for logic and language processing (2).
The cerebellum, or the back of the brain, plays a major role in motor control. It performs the following functions:
- Coordinates voluntary muscle movements
- Maintains balance
- Provides postural control (1).
The brainstem, or the middle of the brain, plays a major role in regulating essential bodily functions, including the following:
- Heart function
It also relays important messages, for example, “This is hot; don’t touch it” (1).
Major lobes of the brain in the cerebrum
The cerebrum: frontal lobes
The frontal lobes are located close to the forehead. They are very important for motor function: the left frontal lobe controls muscles on the right side of the body, and the right frontal lobe controls muscles on the left side of the body. Therefore, if one of the frontal lobes is damaged, motor function on the opposite side of the body will be affected (3).
In addition to motor control, the frontal lobes also play an important role in controlling the following functions:
- Executive functioning
- Problem solving
- Language use
- Emotional expression (4)
The cerebrum: parietal lobes
The parietal lobes are located behind the frontal lobes and in front of the occipital lobes. These lobes interpret information related to the following areas:
- Impulses from the skin, such as temperature, pain, and touch.
- Spatial information, such as shapes, sizes, and distances
- Written language
- Mathematical problems (5)
The cerebrum: temporal lobes
The temporal lobes are located near the ears. They play an important role in the following functions:
- Visual memory (such as facial recognition)
- Verbal memory (such as language processing)
- Understanding others’ emotions and reactions (6)
- Interpreting auditory information (7)
The temporal lobes are also connected to the hypothalamus, which is responsible for controlling the secretion of hormones (7, 8). Therefore, damage to the temporal lobes can also result in hormonal imbalances (8).
The cerebrum: occipital lobes
The occipital lobes are found in the back of the head, and are very involved in tasks related to vision and reading (6). The occipital lobes have a visual receiving area as well as a visual association area, where written language is interpreted. If the visual association area is damaged, children may struggle with reading comprehension (9).
Major parts of the brain in the brainstem
The brainstem: pons
The pons is the biggest part of the brainstem (6). It is located under the midbrain and above the medulla oblongata. The pons connects several different parts of the nervous system, including the cerebellum and the cerebrum. The pons helps with the following tasks:
- Interpreting sensory input in the face
- Controlling facial expressions
- Moving sound from the ears to the brain
- Controlling motor tasks such as biting, chewing, swallowing, and breathing.
- Controlling sleep cycles (10)
The brainstem: midbrain
The midbrain sits above the pons, and is the topmost part of the brainstem. It connects the spinal cord to the rest of the brain. The midbrain is important for the following:
- Processing of visual and auditory signals
- Suppressing pain
- Maintaining alertness
- Coordinating movements (11).
The brainstem: medulla oblongata
The medulla oblongata is the lowest part of the brainstem. It controls the lungs and heart, and regulates critical, involuntary functions such as the following:
- Digestion (6, 12)
Long-term outlook and side effects of neonatal brain injury
Knowing the location of a brain injury can help predict what type of complications a child will face long-term. Of course, the outcome cannot be determined solely based on the assessment of the injury location. It is important to remember that brain injury is an evolving process. When a brain injury is suspected, head imaging should be performed. Brain imaging studies must be repeated because an injury, as seen on imaging, can evolve over days, weeks, and even months. Examining the evolution of injury as well as the final extent of the damage is very important.
Preventing hypoxic-ischemic encephalopathy (HIE) and permanent brain damage with therapeutic hypothermia
Hypoxic-ischemic encephalopathy (HIE) is a type of neonatal brain injury caused by oxygen deprivation (birth asphyxia) and/or limited blood flow to the brain. It can result in lifelong disabilities such as cerebral palsy (CP) and even infant death. However, if a treatment called therapeutic hypothermia is given very shortly after birth (most guidelines say within six hours, although recent research suggests there may be some benefit up to 24 hours), it can halt cellular processes involved in the progression of brain injury. This may minimize, or in some cases even prevent, permanent brain damage.
Other treatments for neonatal brain damage
Babies with brain damage should receive continued evaluation (to assess the spread of injury) and prompt treatment to minimize further harm. In addition to therapeutic hypothermia, this may mean working to prevent complications such as seizures, poor perfusion, imbalances of electrolytes and blood sugar, brain bleeds, respiratory problems, and infections.
Additionally, brain-injured children often benefit from Early Intervention (EI) programs and therapies to maximize their skills and development (e.g. physical therapy, occupational therapy, and speech therapy). They may also require certain medications or surgeries.
How can I tell if my baby has a brain injury?
Seizures are a common sign that a baby has had a brain injury. Sometimes, seizures aren’t recognized until an EEG is performed on the baby. Failure to perform frequent or continuous EEGs can result in a brain injury going undetected for a long time, especially since seizure activity is often the only sign of a brain injury.
However, there may also be other signs. These include the following:
- Low Apgar scores. An Apgar score assesses the overall health of a baby very shortly after birth (at one and five minutes, and repeated at 10, 15, and 20 minutes if the scores are low). It takes into account the baby’s complexion, heart rate, reflex response, muscle tone, and breathing ability.
- Failure to breathe immediately after delivery (need for resuscitation)
- The baby’s blood is acidic and has a low pH (acidosis)
- Difficulty feeding, including inability to latch, suck, or swallow
- Abnormal limpness
- Poor head position
- Multiple organ problems (e.g., involvement of the lungs, liver, heart, intestines)
- No brainstem reflexes (e.g., breathing problems and an abnormal response to light)
- Hypotonia (low muscle tone)
When a pregnancy or birth was difficult or a baby experienced an event that could cause oxygen deprivation or brain bleeds, the medical team must be on the lookout for signs of a brain injury. When a brain injury is suspected, head imaging and other diagnostic tests can be done so the medical team can pinpoint the type of injury, the cause of the injury, and any ongoing processes that can be treated. In addition, if HIE is even remotely suspected in a newborn, the medical team should promptly assess the baby so that therapeutic hypothermia can be given (if indicated).
What complications cause neonatal brain injury?
Conditions that occur near the time of delivery that can cause oxygen deprivation and brain injury include the following (for a longer list, click here):
- Placenta previa
- Ruptured uterus (womb)
- Placental abruption
- Umbilical cord problems, such as a nuchal cord, umbilical cord prolapse, short cord, or cord in a true knot
- Premature rupture of the membranes (PROM)
- Premature birth
- Failure to quickly deliver a baby when fetal distress is evident on the fetal heart rate monitor (delayed emergency C-section)
- Oligohydramnios (low amniotic fluid)
- Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis
- Prolonged and arrested labor
- Stroke in the baby
- Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery. Forceps and vacuum extractors can cause brain bleeds. Mismanagement of cephalopelvic disproportion (CPD), abnormal presentations, and shoulder dystocia also put a child at risk of having a brain bleed.
- Uterine tachysystole (hyperstimulation) caused by Pitocin and Cytotec
- Improperly treated high bilirubin levels (jaundice) that cause a form of brain damage called kernicterus.
- Improperly treated neonatal hypoglycemia (low blood sugar).
- Brain infection such as meningitis, which can be caused by maternal infections that travel to the baby at birth. These maternal infections include the following: Group B Strep (GBS), herpes simplex virus (HSV), urinary tract infection (UTI), bacterial vaginosis (BV) and chorioamnionitis.
Many birth injuries and neonatal brain injuries are caused by the decreased flow of oxygenated blood from the placenta to the fetus’ brain.
Legal help for neonatal brain damage and birth injuries
Reiter & Walsh ABC Law Centers has been advocating for children with brain damage and birth injuries for over three decades. 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 you pay us nothing until we win your case. Contact us today for a free legal consultation:
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Birth injury video: Michigan infant brain injury lawyers discuss birth injuries and neonatal brain damage
Watch a video of Michigan infant brain injury lawyers Jesse Reiter & Rebecca Walsh discussing the causes of brain damage in a baby.
- Everything You Need to Know About the Parts of the Brain. (n.d.). Retrieved August 15, 2018, from https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/anatomy_of_the_brain_85,p00773
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- Hormones and Epilepsy. (2014, January 14). Retrieved August 15, 2018, from https://www.epilepsy.com/living-epilepsy/women/all-women/hormones-and-epilepsy
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- The midbrain. (2018, July 04). Retrieved August 15, 2018, from https://qbi.uq.edu.au/brain/brain-anatomy/midbrain
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