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John J. Hopkins
We work hard to keep our information as relevant and as up-to-date as possible. We strive to educate families on many different types of birth injuries, what the symptoms are, how birth injuries are caused, how they can be diagnosed, what the available treatment is, what the prognosis is, and what assistance programs are available to them.
Cerebral palsy develops due to a brain malformation or injury before, during, or shortly after birth, there is still a lot of mystery as to how, exactly, an infant develops it.
Infant brain damage can happen during pregnancy, during delivery, or after birth. During delivery and shortly after birth, head trauma is one of the leading reasons for infant brain damage.
Currently, there is no cure for cerebral palsy, but extensive research and studies are ongoing. In the meantime, there are a few procedures and treatments that can make your child more comfortable.
A brachial plexus is a group of nerve fibers that run from the spinal cord, through the neck, and down into the arms. A brachial plexus injury occurs when any part of these nerve fibers is damaged. Most often, brachial plexus injuries are caused by excessive stretching or force applied during a difficult delivery. Many brachial plexus birth injuries involve force applied when forceps or a vacuum extraction tool is used to aid delivery.
Childbirth is a physically demanding time for both mother and infant. Bruising and petechiae sometimes result from the birth process as the infant moves through the birth canal. However, extensive bruising or petechiae could be a sign of a more significant injury. Significant bruising or petechiae on the head, neck or shoulders could indicate a birth injury. The types of birth injuries associated with significant bruising are discussed in more detail separately.
Cephalohematoma is a type of birth injury that occurs when blood pools between the skull and inner layers of skin. Cephalohematoma does not cause brain damage, but it can lead to other complications, such as jaundice, infections or abscesses. The possible complications of cephalohematoma are discussed separately.
Cerebral palsy is a disorder characterized by brain damage that affects the infant’s motor functions. Brain damage may occur before, during or shortly after delivery. Depending on the severity of the brain damage, cerebral palsy may cause partial or total paralysis and may contribute to other brain-related disorders. While there is no cure for cerebral palsy, there are treatment options that can help manage symptoms.
Chorioamnionitis occurs when the fetal membranes are inflamed due to a bacterial infection. When this occurs, the placenta and surrounding membranes may be affected, which can disrupt the flow of blood, oxygen and nutrients to the infant. The underlying infection can also be transmitted to the infant through the umbilical cord. Most often, Chorioamnionitis develops due to one of the following infections:
• Group B Strep
• Urinary Tract Infection
• Bacterial Vaginosis
If chorioamnionitis is not treated quickly and properly, the infant becomes vulnerable to birth injuries including:
• Hypoxic Ischemic Encephalopathy (HIE)
• Cerebral Palsy
• Neonatal Sepsis
• Respiratory Problems
• Periventricular Leukomalacia
Erb’s palsy is a type of birth injury that results from physical trauma during delivery. Erb’s palsy is a type of brachial plexus disorder, but only the nerves in the upper arm are affected. The effects of Erb’s palsy vary greatly depending on the severity of the injury and other factors. Erb’s palsy primarily occurs during a difficult delivery and may result from the baby getting stuck inside the birth canal at an awkward angle, excessive pulling during delivery and stress on the brachial plexus nerves during a breech delivery. A more detailed discussion of the causes of Erb’s palsy is available separately. A discussion of possible treatment options for Erb’s palsy is also available.
Fetal lacerations are birth injuries that primarily occur as a result of medical instruments used during labor and delivery. Nicks and cuts from a scalpel, forceps or other instrument can cause injury to the infant’s delicate skin. The risk factors for fetal lacerations include:
• Emergency C-section
• Low transverse uterine incisions
• Inexperienced surgeons or residents
Minor lacerations can be easily treated in the operating room, but others can lead to more serious and long-term problems. Potential problems related to fetal lacerations are discussed separately.
Folic acid deficiency anemia occurs when the body has too few red blood cells. For pregnant women, this can cause anemia, which reduces the amount of oxygen in the blood. As a result, the infant may not receive adequate oxygen and nutrients, which can cause complications with pregnancy, labor or delivery. The potential complications of folic acid deficiency anemia are discussed separately.
Group B strep infection (GBS) is a bacterial infection that affects 25-40% of women. Most women are asymptomatic, which is why doctors recommend all pregnant women be screened around 35-37 weeks gestation. Women who have GBS will be given antibiotics that prevent the bacteria from passing to the infant during delivery. It is important to identify women who have GBS because the bacteria exposes the infant to a number of possible medical conditions, including Meningitis and Sepsis.
Horner’s syndrome is a condition that results from damage to the nerves that connect the brain to the eye and face. Infants who suffer from Horner’s syndrome will experience symptoms only on the affected side of the face. Parents may notice bloodshot eyes, a flushed appearance or different pupil sizes. Horner’s syndrome is considered a rare condition that most commonly occurs as a result of birth trauma. The causes of Horner’s syndrome are discussed in greater detail in separate articles.
Hydrocephalus is a condition that occurs when there is an unusual buildup of cerebrospinal fluid (CSF) in brain cavities called ventricles. CSF is a necessary part of healthy brain function, but if too much CSF accumulates or it cannot be reabsorbed, the infant may experience swelling of the head, headaches, seizures or even coma. Fortunately, with early detection and treatment, hydrocephalus can be treated and complications can be prevented. More details about the potential causes of hydrocephalus are discussed in separate articles.
Infant Bell’s palsy is a medical condition marked by weakness or paralysis on one side of the face. While Bell’s palsy is not considered a serious or long-term condition, it can lead to more serious medical conditions, especially if it is not diagnosed and treated properly.
Millions of newborns suffer from brain damage each year. There are many factors that lead to brain damage, including complications during pregnancy, difficult delivery, and medical negligence. Some causes of brain damage during labor and delivery include:
Hypoxic Ischemic Encephalopathy (HIE)
Umbilical Cord Problems
There are also numerous individual injuries that are caused by brain damage. Brain damage can lead to injuries like cerebral palsy, seizures and developmental delays.
The cause of brain damage and the severity of the injury will determine how the injury is treated. Treating brain damage often requires a multidisciplinary approach. We discuss treatment options for brain damage in more detail separately.
Brain ischemia occurs when there is a lack of blood flow to the brain during labor and/or delivery. When blood flow to the brain is restricted, the infant may suffer brain damage, which can lead to:
Hypoxic Ischemic Encephalopathy (HIE)
There are several causes for brain ischemia birth injuries, which are discussed in greater detail separately.
At the time of birth, an infant’s skin and bones are incredibly fragile. Generally, broken bones during delivery are preventable. Most often, broken bones are a sign that the doctor used excessive force or pressure during delivery. This can occur during a difficult delivery when the infant is too large or becomes stuck in the birth canal. Broken bones can often be prevented by opting for a C-section instead of a vaginal delivery when difficulties arise.
Cephalohematoma is a type of birth injury that occurs when blood pools between the skull and the inner layers of skin. Cephalohematoma does not cause brain damage, but it can lead to other complications, such as jaundice, infections, or abscesses. The possible complications of cephalohematoma are discussed separately.
Cervical torticollis is a neurological condition that causes an infant’s neck muscles to snap back and contract involuntarily. This causes the infant’s head to move forward and backward or from side to side. It can be incredibly painful for the infant. Infant cervical dystonia is most often caused by birth trauma during labor and delivery. It can result in additional injuries, such as hypoxia and bleeding in the brain.
Hypoxic Ischemic Encephalopathy, or HIE, occurs when an infant’s brain does not receive adequate oxygen and blood. As a result, the infant may suffer damage to the brain and other organs. HIE can occur shortly before delivery, during labor and delivery, or shortly thereafter. There are a variety of complications and injuries that can lead to HIE. These possible causes are discussed separately.
Treating HIE depends on the severity of the damage to the infant’s brain. Treatment options are discussed in the following articles.
Meningitis occurs when a bacterial or viral infection spreads into the cerebrospinal fluid that protects the brain and spinal cord. Infants can develop meningitis if they are exposed to bacteria during pregnancy or delivery, such as Group B Strep. Doctors should screen pregnant women between 35 and 37 weeks of pregnancy to determine if there is a risk of bacterial infection or meningitis. Learn more about infant meningitis in these separate articles.
Many infants experience seizures. Infant seizures can be the brain’s way of telling us that something is wrong. In many cases, the cause of the seizure is identified and the infant recovers quickly. However, infant seizures can also be an indication of a more serious problem. Seizures can indicate brain damage due to:
Anoxia or Hypoxia
Group B Strep Infection
These types of brain damage may be due to medical negligence, complications or congenital factors.
Shoulder dystocia is a complication that occurs during delivery. It happens if the infant is proportionately too big to fit easily through the birth canal. As a result, the infant’s shoulders become stuck in the birth canal. Some of the factors that may lead to shoulder dystocia include:
An infant’s shoulders being stuck in the birth canal makes delivery incredibly difficult and puts stress on the infant. If the doctor attempts to force vaginal delivery, the infant may suffer injuries.
More details on the injuries often associated with shoulder dystocia are discussed separately.
Skull fractures are a leading cause of disability and death among children. During labor and delivery, a skull fracture can occur as a result of difficulties, such as the infant becoming stuck against the mother’s pelvis, the infant is too large for vaginal delivery or the infant being too small for vaginal delivery. In such cases, the physician may use birth-assisting tools or more forceful maneuvers to attempt delivery. The pressure applied to the infant’s skull can result in a fracture. Another possible cause of skull fractures is the newborn being dropped by a doctor or nurse.
Infant skull fractures can lead to a host of complications and other medical conditions, such as:
Bleeding in the brain
Infant spinal cord damage occurs most often due to blunt force trauma or a medical condition that affects the spine. These injuries can also result from a doctor’s failure to diagnose a medical condition like spina bifida. Children who have spina bifida are vulnerable to spinal cord injuries because the vertebrae does not adequately protect the nerves. If a doctor or nurse touches or damages the nerves, the infant could face long-term disabilities.
Spinal cord injuries caused by birth trauma may result from a difficult labor and delivery or the doctor’s use of birth-assisting tools. These possible causes of infant spinal cord damage are discussed in more detail separately.
A subconjunctival hemorrhage occurs when the small blood vessels just beneath the eye rupture. As a result, blood pools beneath the clear membrane that covers the eye (the sclera). Infants who have a subconjunctival hemorrhage may have a red spot on the white part of their eye.
The most common causes of a subconjunctival hemorrhage include birth trauma or pressure during delivery. These injuries are most common in infants who are large for their gestational age, or who are having a difficult time making their way down the birth canal
A subconjunctival hemorrhage can be scary, especially if the infant’s eye is really red. Fortunately, the prognosis for these birth injuries is generally favorable.
A wrongful death is defined as the death of one individual caused by the negligence or carelessness of someone else. An infant wrongful death may result from the negligence of a doctor, nurse, midwife or hospital. Some examples of infant wrongful death include:
Failure to warn an expectant mother of a pregnancy complication
Failure to properly monitor fetal vital signs
Inappropriate use of force when using forceps or vacuum extraction
Failure to recognize fetal distress
Improper prescribing or administration of medication
Parents who have lost an infant due to wrongful death may be able to sue the person(s) responsible. It is important to speak with a birth injury lawyer before attempting any action.
Possible causes of infant wrongful death are discussed in more detail in the following articles.
Bleeding in the brain is also called an intracranial hemorrhage. An intracranial hemorrhage that occurs during childbirth may be the result of birth trauma or an accident, such as the newborn being dropped. In some cases, birth-assisting tools like forceps or a vacuum extractor can also contribute to intracranial hemorrhages. Most intracranial hemorrhages require surgery to stop the bleeding and prevent brain damage.
Kernicterus is a dangerous complication of jaundice. It most often develops when jaundice is not diagnosed or treated in a timely manner. Kernicterus is caused by high levels of bilirubin in the blood, which can lead to brain damage. As the condition progresses, the infant may suffer from a variety of symptoms ranging from mild (fatigue) to severe (seizures). Without immediate treatment, kernicterus can further develop into:
Athetoid Cerebral Palsy
Klumpke’s palsy is a type of birth injury that affects the lower portion of the brachial plexus network of nerves. When two of the lower five nerves are injured, the infant experiences paralysis in the hand and forearm, and sometimes the wrist. The severity of the injury depends on the extent of damage to the nerves. Most often, Klumpke’s palsy results from birth trauma, such as:
Cephalopelvic Disproportion (CPD)
Abnormal Fetal Presentation
Sometimes the nerves heal on their own without incident. Other times, treatments may be necessary.
Periventricular Leukomalacia (PVL) is a type of infant brain damage that causes the cells in the white matter of the brain to decay or die. This results in an empty space in the brain where fluid builds up. The primary causes of PVL are:
Infant Brain Damage
It is important that PVL is diagnosed quickly and interventions started to give the infant the best chance of recovering. Treatment options for PVL include a variety of therapies and injury-specific treatments for vision, hearing or speech difficulties. Research suggests that 60-100% of infants with PVL will develop cerebral palsy as well.
Neonatal sepsis occurs when an infection progresses into the bloodstream causing severe illness. Most often, neonatal sepsis results from a maternal infection, such as Group B Strep infection or Escherichia Coli (E. Coli). One of the most common non-bacterial causes of neonatal sepsis is the herpes simplex virus.
Neonatal sepsis is a medical emergency and should be treated immediately to avoid possible complications, such as:
Risk factors for neonatal sepsis include:
Group B Strep Infection
Forceps Delivery Injury
With quick diagnosis and treatment, infants with neonatal sepsis can recover without additional problems. Serious cases, however, may result in the infant experiencing more long-term problems.
A stroke occurs when the blood supply to the infant’s brain is disturbed. A neonatal stroke can occur anytime within the first 28 days of life. A perinatal stroke occurs during the first seven days of life. The cause of a neonatal stroke is hypoxia – or not enough oxygen to the brain. As a result, the brain panics and cells are damaged or begin to die. There are many things that can cause a neonatal stroke, including:
Congenital Heart Disease
There are generally no outward symptoms of neonatal stroke, but some parents do observe seizures. Treatment options for neonatal stroke include Hyperbaric Oxygen Therapy, Neonatal Therapeutic Hypothermia, and Assistive Technologies.
Jaundice is a medical condition that affects many newborns. It occurs when too much bilirubin – a yellow-orange pigment that occurs in red blood cells – is not properly flushed out by the liver. Most parents recognize jaundice by the yellowing of the skin and whites of the eyes. In most cases, jaundice is not dangerous and can easily be treated. However, sometimes jaundice progresses or results in potentially dangerous complications.
If bilirubin levels get too high and the liver cannot process it out, the infant may experience hyperbilirubemia. Hyperbilirubemia is a serious condition that can lead to kernicterus, a dangerous complication of jaundice. Kernicterus can cause brain damage, which can then lead to other medical conditions.