Newborn Brain Injury

Cerebral palsy (CP), the most common motor disability in childhood, is a group of disorders that affects muscle tone, posture and/or movement due to abnormal brain development or damage to the developing brain.

About 85-90% of cases of cerebral palsy cases are congenital CP, which is related to brain damage that occurs before or during birth. A small percentage of CP cases are ”acquired CP,” meaning it was caused by brain damage (usually an infection, such as meningitis, or a head injury) that occurs in the first few months or years of life, while the brain is still developing.

Many people with cerebral palsy have additional symptoms that accompany the motor abnormalities, including intellectual disability, communication and behavior difficulties, seizure disorders, problems with vision, hearing, swallowing, and speaking, difficulty with precise movements, and musculoskeletal complications.

Unfortunately, many risks and adverse events can occur during the birthing process, both during the prenatal period and during the birth itself that can cause brain damage resulting in cerebral palsy. In some cases, the brain damage could have been prevented with the exercise of reasonable medical care.

There are a few different kinds of cerebral palsy that are classified based upon the type of movement disorder involved, which often correlates with which parts of the brain are affected.

• Spastic cerebral palsy, the most common type of CP, is when someone has stiff muscles and, as a result, their movements can be awkward. Spastic diplegia is stiffness mainly in the legs and less severely in the arms and face, spastic hemiplegia is stiffness on one side of the body, typically the arm and hand, but can also include the leg, and spastic quadriplegia, the most severe form of spastic cerebral palsy, affects all four limbs, the trunk and the face.
• Dyskinetic cerebral palsy is when someone has uncontrollable movements (slow and writhing or rapid and jerky) of their hands, arms, feet and legs, making it difficult to sit and walk.
• Ataxic cerebral palsy is when someone has balance and coordination difficulties
• Mixed cerebral palsy is when someone has symptoms from more than one type of cerebral palsy.

The signs and symptoms of cerebral palsy can vary dramatically because there are many different types and levels of disability. For example, a child with severe CP might not be able to walk at all and require lifelong care, while another child with mild CP might walk only a little awkwardly and require no special assistance.

However, the most common symptoms are delays in reaching motor or movement milestones (like sitting, standing, or walking). Other early signs that children with CP may exhibit include:

• In babies younger than 6 months, they may feel stiff or floppy when held, or cross or scissor their legs.
• In babies older than 6 months, they cannot bring their hands together or don’t roll over in either direction.
• In babies 10 months or older, they may crawl in a lopsided manner or scoot/hop rather than crawl.

The signs of cerebral palsy usually appear in the early months of life; however the diagnosis may be delayed until age two years or later. To diagnose cerebral palsy, it is important to monitor a child’s growth and development and perform a developmental screening if a parent is concerned about the child’s development. If doctors further suspect cerebral palsy, they will refer for developmental and medical evaluations to further work-up the condition.

The disorder itself is not progressive, however, the exact symptoms may change over time.

Abnormal development or damage to the fetal or infantile brain has several possible causes and is often multifactorial. Examples of possible causes include: history of prematurity, fetal growth restriction, multiple gestation, maternal infection or fever during pregnancy, lack of oxygen during the birth process, genetic abnormalities and congenital brain malformations.

There are several ways that cerebral palsy could be caused by the negligence of a health care provider. For example:

• Improper handling of maternal infections: Certain infections in the mother can increase the risk of cerebral palsy to the baby. Types of infections that have been linked to CP include cytomegalovirus (CMV), varicella virus (chickenpox), toxoplasmosis, and bacterial infections such as infections of the placenta or fetal membranes or maternal pelvic infections. Health care providers may be negligent in their handling of maternal infections, including failing to screen, diagnose and/or treat pregnant women for infections in a timely manner.
• Failure to deliver the baby in a timely manner: During the birthing process there may be negligent care, such as delaying a cesarean section too long or failure to properly monitor labor progression or pick up on ominous fetal heart-rate patterns, which can result in the baby suffering a lack of oxygen (asphyxia) and cerebral palsy due to brain damage.
• Failure to diagnose and treat jaundice: Severe jaundice that is left untreated can cause a type of brain damage called kernicterus, which can result from high levels of bilirubin in a baby’s blood. Kernicterus is a cause of cerebral palsy that may be prevented with early diagnosis and treatment of jaundice.
• Failure to recognize and manage Rh incompatibilities: Rh disease, also called Rh incompatibility, happens when the mother’s blood is Rh-negative and the baby’s blood is Rh-positive. Rh incompatibility can cause serious problems for the baby including severe jaundice and kernicterus. Rh disease usually can be prevented with treatment and care at the right times.
• Failure to communicate: According to a 2015 study conducted by CRICO Strategies, 34% of all obstetrics-related malpractice cases involved communication errors. Top communication factors among obstetric cases were: miscommunication of among obstetrical team members, poor documentation of clinical findings, miscommunication due to a language barrier, and inadequate informed consent.  There are many ways that failure to communicate can lead to brain damage resulting in Cerebral Palsy.  For example, a nurse may fail to communicate a sense of urgency to the OB regarding possible decelerations on the electronic fetal monitoring strips, leading to the baby suffering a loss of oxygen and cerebral palsy due to brain damage. 

There are many additional ways cerebral palsy can occur due to medical malpractice, so it is best to have an experienced medical malpractice lawyer review your potential case.

There is no cure for cerebral palsy, and there is no single treatment that works for all children with CP, but there are many treatment options for parents to help improve the lives of their children with CP. Some of the most common types of treatment include:

• Physical, occupational and speech therapy: Physical therapy is a cornerstone of CP treatment and includes exercises and activities that can help children maintain or improve muscle strength, flexibility, balance, and motor skills. Occupational therapy focuses on fine motor skill development and self-help skills and includes exercises to address everyday activities such as feeding, toileting, dressing, going to school, and personal hygiene. Speech and language therapy can improve a child’s ability to speak clearly, help with eating and swallowing difficulties, and learn new ways to communicate such as, using sign language or computer-based communication devices.
• Orthotic devices: braces, splints, and casts can all be used to help improve movement and function, such as walking and stretching spastic muscles.
• Medication: medications can help relax painful, stiff, overactive muscles. Medications may also be used to reduce drooling.
• Surgery: sometimes surgery is recommended for patients with CP who have severe problems with spasticity and stiffness, such that walking and moving about are difficult or painful, in order to try to ease the chronic pain, help relax the muscles and improve mobility.

Many of these therapies come at a high financial cost to the family of the injured child. Health insurance should cover most of the expenses, but out-of-pocket costs may be difficult for many families to afford.