Cerebral Palsy Causes: Hypoxia, Infection, and Brain Damage

I write a lot about birth injuries on this website because it’s one of my passions. Even though I had already practiced as a birth injury lawyer by then, after my twins were born more than three months early, I often stayed up all night looking for as much information as I could find about their odds of survival, the chances of having permanent injuries, and about neonatology in general. My wife and I learned so much about ventilator settings that many of the nurses thought we were pulmonologists.

It’s my hope that, if a parent is out there looking for information about medicine or about malpractice law, they’ll learn something from my site and, if they suspect malpractice, contact a lawyer. I have known many parents of children with cerebral palsy who were never told, and did not suspect for years, that the CP may have been preventable if the doctors had treated them appropriately during the pregnancy or birth. There are many law firms, including mine, that will review cerebral palsy cases confidentially and free of charge. There’s no harm in getting a second opinion on the doctors’ and nurses’ treatment.

Cerebral palsy means “brain paralysis” and is a term used to describe a neurological disorder that can cause problems with muscle control, balance, and posture.  Cerebral palsy is often caused by brain damage in pregnancy or at birth, and can lead to delays in developmental milestones such as rolling over, sitting, crawling, feeding and walking.

Common causes of cerebral palsy include:

  • Hypoxia, or lack of oxygen to the baby’s brain, during labor or delivery;
  • Asphyxia, which is an obstruction to the baby’s umbilical cord or breathing after birth;
  • An infection during the pregnancy or immediately after birth, like meningitis;
  • Premature birth, which exposes the baby’s brain to stresses not normally encountered until the brain has further developed during pregnancy

In many situations, these conditions are preventable or treatable, but many doctors, nurses, and midwives fail to properly recognize the signs and symptoms of fetal hypoxia and infection in pregnant women or women who have gone into labor. The most common NICU diagnosis after malpractice is “hypoxic ischemic encephalopathy,” which is a fancy way of saying “a brain injury due to a lack of oxygen in the blood.” You can read more about the diagnosis in this medical review, and more about the prognosis after perinatal asphyxia in this medical paper.

Many studies, however, caution against using early MRIs and other brain scans as a way of predicting how severe a child’s disabilities are. That’s part of why physical therapy is so important in the early years: it can make a huge difference, even in the most severe cases. Watching milestones is far more important than looking at some brain scan right after the child was born. Here are the milestones for one year and three years.

Many in the medical community have tried to dismiss the notion that hypoxia is a common cause of cerebral palsy, but the science is undeniable. Although there are many risk factors during pregnancy that can increase the likelihood that a child is born with cerebral palsy — such as gestational diabetes, undiagnosed or uncontrolled hyperthyroidism or hypothyroidism, pre-eclampsia (high blood pressure), maternal seizures, and multiple births such as twins and triplets — cerebral palsy is often caused by problems that occur during labor and delivery and the negligent treatment of these conditions by physicians and hospitals.

As one example of medical malpractice, obstetricians and delivery nurses are trained to recognize that unusual changes in the baby’s heart rate such as decelerations or bradycardia (low heart rate) can indicate the possibility of another problem, such as fetal distress, and so treatment options like an emergency caesarian-section operation should be considered. In many situations, however, the problems either go undiagnosed or are ignored, thereby exposing the baby to a prolonged deprivation of oxygen.

As another example of medical malpractice, obstetricians are supposed to investigate the position of the baby to assess whether the baby is in a breech position, whether the baby has a “nucal cord” (where the umbilical cord is wrapped around the baby’s neck), and whether the baby is responding appropriately to the mother’s contractions. Yet, these potentially dangerous problems are often treated improperly, with doctors either improperly attempting a vaginal delivery or inappropriately giving mothers Pitocin to speed up delivery, despite the potential for harm.

As another example, doctors and nurses should always be alert for problems with the placenta, such as placenta previa (where the placenta covers the cervix and causes bleeding as cervix dilates during labor) and placental abruption (where the placenta pulls off the uterus, decreasing blood flow to the baby), but many health care providers dismiss complaints about bleeding as being normal or showing “old blood” that does not indicate a current problem with the fetus’ oxygen supply. Similarly, although doctors and nurses should also investigate every large discharge of fluid to assess whether the amniotic sac has developed a leak (called “premature rupture or membranes”) to ensure the leak does not remain open (called “prolonged rupture of membranes”), many health care providers dismiss any complaints about unusual discharges.

All of the above examples of malpractice can lead to hypoxia, causing secondary damage to the brain like intraventricular hemorrhages (“IVH,” or bleeding within the ventricles of the brain) or periventricular leukomalacia (“PVL,” where the brain tissue around the ventricles begins to die) and, later, cerebral palsy.

Medical negligence during pregnancy or birth is, however, not the only cause of cerebral palsy. Cerebral palsy can also be caused by:

  • cardiac defects or heart problems;
  • metabolic or digestive problems;
  • malnutrition in an infant;
  • meningitis or an infection in the brain;
  • drug or medication errors;
  • TPN or total parental nutrition mistakes;
  • incorrect IV or intravenous fluid;
  • low blood sugar after birth or hypoglycemia;
  • jaundice, kernicterus or a high bilirubin level; or,
  • lead poisoning.

Many of the above instances involve malpractice, such as where meningitis or hyperbilirubinemia went undiagnosed or untreated, but many do not. In many instances, problems in the pregnancy should have prompted the OB/GYN to refer the patient to a specialist in Maternal-Fetal Medicine for more rigorous monitoring, but the OB/GYN failed to do so.

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