Hearts break when a newborn exhibits signs of brain damage in the first hours and days after birth. The tragedy is felt by parents, extended family and among the baby’s medical team, too. Calling in lawyers has become a typical reaction because general understanding has been that a full-term baby with a damaged brain was probably injured during delivery. It must be the fault of the doctor, medical team, or the facility, right?
No, not always. Recent advances in medical science indicate many brain injuries occur during pregnancy, long before labor begins. In these cases, medical personnel are not at fault.
Neonatal Encephalopathy Numbers
A common cause of newborn brain injury (neonatal encephalopathy) is oxygen deprivation (asphyxia). The most severe form of injury is cerebral palsy, which isn’t always caused by asphyxia during delivery.
According to an updated version of the Neonatal Encephalopathy and Neurologic Outcome report, only three babies born at full term out of every 1,000 full-term babies experience brain injury. In only about half of these injuries, some degree of asphyxia occurred during labor and delivery. Fewer than 10% of children diagnosed with cerebral palsy exhibit symptoms of oxygen deprivation during delivery.
A new understanding of the symptoms of neonatal brain abnormalities make it possible to determine if oxygen deprivation during the birth process caused the injury. In many cases, symptoms suggest damage was already evident and possibly exaggerated by moments of reduced oxygen during delivery.
In addition to asphyxia during delivery, a full-term baby may suffer brain damage due to:
- Genetic factors
- Maternal health problems, such as hypothyroidism
- Placental abnormalities or lesions
- Excessive bleeding during pregnancy
- Fetal membrane infection
- Fetal stroke
- Fetal growth retardation
Symptoms of Injury
Some symptoms of injury may seem evident at birth but it takes days to fully assess the extent of the damage. To determine the cause of the injury, all symptoms must be compared individually and in combination over a period of time. The higher the number of these symptoms, the greater likelihood asphyxia contributed to damage:
- Seizures or impaired consciousness
- Breathing difficulties
- Poor muscle tone
- Sluggish reflexes
- Low Apgar Score at 5 and 10 minutes
- Acidemia (high acidity) in the umbilical artery
- Major organ failure
- MRI that shows a particular pattern of brain injury
Prevention and Intervention
Sometimes the fetal heart rate hints of trouble. When this occurs early in labor, a aesarean-section delivery often prevents further damage.
When oxygen deprivation occurs during delivery, induced hypothermia can minimize damage. This treatment involves safely reducing a baby’s body temperature from 98.6 degrees to 92.3 degrees for 72 hours.
Pinpointing the Moment of Injury
If an MRI scan on the day of birth indicates damage, the damage probably occurred before delivery. A second MRI plus assessment of other symptoms on day 3 can determine if damage was caused before birth or by asphyxia during delivery. An MRI on day 10 reveals the extent of injury by any cause.
The intent of the revised Neonatal Encephalopathy and Neurologic Outcome is to use new medical insights to change the current culture of name-and-blame by shifting attention to prevention of medical error. This approach is more constructive and professional while minimizing threat to the medical staff and facility. Doctors who feel they must defend their every move are less likely to report potentially damaging events. Failure to report suspicious events makes corrective action and future preventive measures less likely.
Source: “Executive Summary: Neonatal Encephalopathy and Neurologic Outcome, Second Edition.” Obstetrics & Gynecology. The American College of Obstetricians and Gynecologists / Lippincott Williams & Wilkins. Apr 2014. Web. Jun 7, 2014.