Brain Damage in a Baby: Brain Scans for Assessing Risk of Cerebral Palsy, Developmental Delays
When brain damage is suspected in a newborn baby, brain scans are crucial for diagnosing and treating the injuries. Magnetic resonance imaging (MRI) and cranial ultrasonography (CUS) are head imaging techniques, often called brain scans, that give doctors pictures of the baby’s brain. MRI and CUS can help diagnose injuries such as hypoxic-ischemic encephalopathy (HIE), brain bleeds, hydrocephalus and brain hemorrhages, which must be promptly treated. Head imaging helps doctors determine if important structures of the brain, such as the basal ganglia, are injured. In addition, brain scans can show swelling in the brain, called edema. When edema occurs in the first day or so after delivery, it is a strong indicator that the baby experienced a brain insult during or near the time of birth, called a birth injury. Edema is a consequence of HIE. In fact, brain bleeds, hemorrhages and hydrocephalus can all result from HIE. These conditions can also cause HIE and affect the pressure inside the baby’s brain (ICP). Abnormal brain pressure can lead to brain damage. Recognition of elevated ICP is very important so that efforts can be made to normalize it.
Brain Damage in Babies: Long-Term Outcomes
Conditions that can be caused by an insult to the baby’s brain include the following:
- Hypoxic ischemic encephalopathy (HIE) usually involves damage to the basal ganglia and watershed regions of the brain, but sometimes also includes periventricular leukomalacia (PVL).
- Brain bleeds and hemorrhages, such as an intraventricular hemorrhage (IVH) and subdural hemorrhage / hematoma
- Neonatal encephalopathy
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Motor disorders
- Periventricular leukomalacia (PVL)
The Importance of Multiple Brain Scans for Neonatal Brain Damage
Brain scans give important information for diagnosis and treatment of brain injuries and related medical conditions in the baby. Scans also help doctors assess a baby’s risk of having cognitive, developmental or motor problems during the toddler years. Predictions may be made about the child long-term, but quite frequently, the long-term effects of neonatal brain damage aren’t fully known until the child reaches school age.
A study published in Pediatrics found that brain scans performed before birth are better predictors of neurodevelopmental outcomes than scans done near the time of birth. In fact, when the later scans were considered in the investigators’ mathematical model, the results added no value in predicting neurodevelopmental outcomes in the toddler years.
Of course, the early scans are essential. They help detect conditions that need to be medically managed right away, such as brain bleeds and edema. And brain imaging is especially important for premature babies who are at risk for neurodevelopmental impairment. Any newborn, regardless of age, suspected of experiencing an insult to the brain during or near the time of birth, however, must be assessed for brain injury / encephalopathy.
Hypoxic ischemic encephalopathy (HIE) should be diagnosed within 6 hours of the time the brain experienced an insult because babies who are eligible for HIE hypothermia treatment need it within 6 hours. Early intervention is critical for babies who experienced brain insults and a lack of oxygen to the brain. The longer injurious brain conditions are left unmanaged, the higher the risk of permanent brain damage.
When are Brain Scans Performed on Babies with Suspected Brain Injury?
Multiple brain scans are essential because newborn brain injury evolves over hours, weeks and days. In addition, an injured brain may make the baby susceptible to later development of brain bleeds, hydrocephalus and other conditions that require prompt treatment.
Often, brain injury in a newborn baby occurs during or close to the time of birth. When a brain injury is suspected, doctors will look for signs and symptoms of global brain dysfunction, also known as neonatal encephalopathy. Some forms of brain damage can be seen at 12 – 24 hours after birth, and edema is usually evident at this time as well. An MRI can usually show moderate to severe forms of HIE within 12 to 24 hours of birth.
When a premature baby has periventricular brain damage, the damage will usually be evident on the CUS when the baby is 24 hours old, and cystic changes will typically be seen after approximately one to three weeks. An MRI is best for assessing the extent of white matter brain damage and it can usually show brain injury by 1 day of age. Once the initial brain damage is established in a baby, serial scans should be done so the medical team can evaluate the changing brain injury. Sometimes radiologists miss evidence of brain damage on a scan or the damage may not be evident. Thus, it is not uncommon for scans to be performed every day when a baby shows signs of a brain injury.
Brain bleeds in a baby can be diagnosed right away with CUS. An intraventricular hemorrhage (IVH) is a significant cause of brain injury in premature babies. Most cases of IVH take place within the first five days after birth. Some occur and can be detected before one hour of age. A subdural hemorrhage is the most common type of intracranial hemorrhage in newborn babies. When babies don’t have symptoms, a CUS performed for suspected head trauma or brain injury can easily detect this type of bleed. When a baby has symptoms of a subdural hemorrhage / hematoma, they usually occur within the first 24 – 48 hours of life. CUS helps the medical team determine the location and extent of brain bleeds and hemorrhages in babies.
A subgaleal hemorrhage is one of the most serious types of brain bleeds in a baby and it is almost exclusively caused by a vacuum extraction delivery. When a baby has a severe subgaleal hemorrhage, the head swelling may be evident right after birth, although swelling usually develops over a 12 – 72 hour period. Computed tomography (CT scans) and MRIs are useful for differentiating a subgaleal hemorrhage from other cranial medical conditions.
IVH or another type of brain insult can cause the baby to have hydrocephalus, which is a condition in which there is head swelling caused by brain ventricles that are enlarged due to problems with the flow of cerebral spinal fluid (CSF). In a newborn, CUS is used for the initial diagnosis of hydrocephalus, but a MRI can better show the extent of the condition, especially the CSF pathway. When a baby gets older and part of her soft spot closes, CUS can no longer be used and CT or MRI must be performed for diagnosis and assessment of the baby’s hydrocephalus. Hydrocephalus may be present at birth or shortly thereafter and must be quickly diagnosed and treated.
There are numerous conditions that can cause a baby to have brain damage. Prompt diagnosis of a brain injury is crucial so the medical team can undertake interventions to minimize or prevent permanent brain damage in the baby.
What Causes Brain Damage in a Baby?
Brain damage in a baby can be caused by many factors. One of the most common causes of brain damage in a baby is birth asphyxia (a lack of oxygen to the baby’s brain during or near the time of birth). The following conditions can cause severe birth asphyxia in a newborn:
- Placental abruption
- Uterine rupture
- Prolapsed umbilical cord
- A very slow heart rate in the baby (terminal bradycardia)
Severe or total asphyxia is also called acute near total asphyxia or acute profound asphyxia. This type of birth asphyxia usually causes injury to the deep gray nuclei of the brain, affecting many levels of the central nervous system. When the asphyxia is abrupt and severe (acute near total), deep structures in the brain, such as the basal ganglia, thalamus and brain stem, are typically injured.
When the baby suffers asphyxia that is moderate to severe and relatively prolonged (acute profound), injury will typically be seen in the cerebral cortex as well as the deep brain structures, particularly the putamen and thalamus.
The conditions listed below can cause a baby to experience partial prolonged asphyxia:
- Use of the labor drugs Pitocin and Cytotec
- High blood pressure in the mother (hypertension)
- Low maternal blood pressure (hypotension), which can be caused by mismanaged anesthesia, maternal infection and dehydration
- Umbilical cord compression caused by a nuchal cord (cord wrapped around baby’s neck)
- Oligohydramnios (low amniotic fluid)
- Placental insufficiency
- Inadequate or delayed resuscitation of the baby at birth
Partial prolonged asphyxia usually lasts for more than 30 minutes and it mainly causes injury in the watershed and parasagittal regions of the cortex, which are areas that do not have direct arterial blood supply.
Babies can also experience both severe birth asphyxia and partial prolonged asphyxia, which will cause a mixed brain injury pattern.
Can Birth Asphyxia Be Cured? Can Permanent Brain Damage in a Baby Be Prevented?
When a baby experiences an event that causes a lack of oxygen to her brain and birth asphyxia, the doctor should deliver her right away be emergency C-section to minimize the time and severity of the asphyxia. As soon as a mother is admitted to the labor and delivery unit, the baby’s heart rate should be monitored by a fetal heart rate monitor. If the baby starts to experience a lack of oxygen to her brain, the heart monitor will show nonreassuring tracings. The medical team must pay close attention to the tracings so they can intervene if the tracings become nonreassuring. Usually a prompt C-section delivery is the best intervention.
If the doctor does not deliver the baby quickly enough when she is experiencing birth asphyxia – or some other insult to the brain (such as a maternal infection that infects the baby at birth) causes brain injury – the medical team must promptly diagnose neonatal encephalopathy and brain injury so that interventions that maintain oxygenation and adequate blood flow to the brain can take place. Brain bleeds must be quickly diagnosed and treated, blood pressure must be normalized, prompt and thorough resuscitation of the baby should take place if needed, and adequate oxygenation and ventilation must occur. Other medical interventions that can minimize or prevent brain damage include prevention of high ICP, prompt treatment of infection or suspected infection, and quick diagnosis and treatment of sepsis.
If the doctor suspects that the baby experienced birth asphyxia, the newborn should be quickly assessed for hypoxic ischemic encephalopathy (HIE), which is a brain injury caused by an oxygen-depriving insult. There is a groundbreaking treatment for HIE called hypothermia (brain cooling) treatment, but it must be given within 6 hours of birth. Hypothermia treatment halts almost every injurious process that starts to occur when the baby’s brain experiences an oxygen-depriving insult. Research shows that the treatment can minimize brain damage and, in some cases, prevent the baby from developing cerebral palsy.
Award-Winning Lawyers Helping Children with Birth Injuries Since 1997
If you are seeking the help of a lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost three decades.
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers 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 nationally recognized birth injury 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.
Free Case Review | Available 24/7 | No Fee Until We Win
Video: Cerebral Palsy
Michigan birth injury lawyer Jesse Reiter discusses the causes and signs of cerebral palsy.
- Hintz, Susan R., et al. “Neuroimaging and neurodevelopmental outcome in extremely preterm infants.” Pediatrics 135.1 (2015): e32-e42.
- Barnette AR, Horbar JD, Soll RF, et al. Neuroimaging in the evaluation of neonatal encephalopathy. Pediatrics 2014; 133:e1508.
- Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy. Obstet Gynecol 2014; 123:896.
- Wu YW, Backstrand KH, Zhao S, et al. Declining diagnosis of birth asphyxia in California: 1991-2000. Pediatrics 2004; 114:1584.
- Graham EM, Ruis KA, Hartman AL, et al. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008; 199:587.
- Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: incidence, clinical course and outcome in a Swedish population. Acta Paediatr 1995; 84:927.
- Lee AC, Kozuki N, Blencowe H, et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res 2013; 74 Suppl 1:50.
- Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33:696.
- Ferriero DM. Neonatal brain injury. N Engl J Med 2004; 351:1985.
- Dammann O, Ferriero D, Gressens P. Neonatal encephalopathy or hypoxic-ischemic encephalopathy? Appropriate terminology matters. Pediatr Res 2011; 70:1.
Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy. Obstet Gynecol 2014; 123:896.