Brain Injury Basics and Signs of Medical Error

By Lee Vander Loop

The term “brain injury” conjures up scenes of horrific accidents: a teen diving into shallow waters, a car crashing, a motorcycle catapulting off a highway, a football player lying immobile on the field. Rarely does it call up images of a newborn lying in a bassinet. But to the parents of some 8,000 infants born in the U.S. each year, this is their reality.

About 70% of children who have cerebral palsy are born with it. This is known as congenital cerebral palsy and it arises from a brain injury prior to birth. Although it is present at birth, it may not be detected for months.  Another 10% acquire cerebral palsy after birth due to brain damage in the first few months or years of life. This is known as acquired cerebral palsy and could be caused by infections such as viral encephalitis or bacterial meningitis, or a traumatic head injury.

A full 20% are diagnosed with congenital cerebral palsy due to a brain injury during the birthing process. Many of these could have been prevented. Lack of adequate training in how to read fetal heart monitor (FHM) tracings, absence of a unified vocabulary among medical personnel in how to translate and communicate FHM findings, differences in quality of care among facilities, medical and nursing errors –all play a part in preventable birth injuries such as cerebral palsy.

Signs of Medical Error during the Birth Process

1. 1. Nurses express or show signs of concern about fetal heart monitor tracings
2. 2. A physician does not respond, or is slow to respond, to nursing calls for consultations
3. 3. An emergency C-section is ordered and is then delayed
4. 4. Hospital personnel will not readily and thoroughly share information with parents about what occurred during a complicated birth

What Parents Need to Know about Brain Injury at Birth

Whether the injury was preventable or not, the consequences of brain injury are often not predictable.  However, parents should be aware of the general aftermath of a brain injury at birth:

1. 1. The infant will most likely require tube feeding intervention and nutritional support at birth due to an inability to suck
2. 2. The newborn may need ICU level care for breathing and life support intervention and assistance due to cerebral swelling and trauma

What to Do if You Suspect a Birth Injury

Many parents leave the hospital with a brain injured newborn and no information as to the cause or level of severity.  It is important that all brain injuries that occur at birth be reviewed for cause and possible future prevention.  If you believe your child may have suffered a preventable birth injury:

1. 1. Consult with legal representation for answers and guidance
2. 2. Request all copies of medical history documenting the birth
3. 3. Ask for the child’s Apgar score; a low Apgar score would be indicative of a birth injury that could result in brain injury

Brain Injury Risk Factors

Research has discovered a significant increased risk of brain injury to full term and preterm infants resulting from a number of factors.  Fact Sheets provided by the Cerebral Palsy International Research Foundation provide information focused on causes of cerebral palsy among infants including:

• Maternal intra-uterine infections
• In utero stroke
• Low birth weight
• Premature delivery
• Maternal substance abuse
• Neonatal encephalopathy, otherwise known as birth asphyxia. Asphyxia can result from umbilical cord complications in utero or neonatal (immediately before and during delivery) whereby blood and oxygen supply to the infant is compromised.
• Breech deliveries, or when forced extraction is necessary by means of forceps, vacuum or the use of instrumental forces during vaginal deliveries

Birth injuries as the result of preventable medical error are rare. But they do occur. Parents who are armed with this knowledge will be in a better place to advocate for their child should the need arise. The Cerebral Palsy Family Network offers a booklet, “Secrets to Safer Childbirth: Preventing Medical Errors in Pregnancy, Labor and Delivery,” to provide more information to expectant parents.