Infant Brain Damage - Causes

NewbornApproximately 1 million people in the U.S. are currently living with some degree of damage or injury to their brain. The overwhelming majority of these people suffered their brain injury before they were even born. Brain damage to infants can occur during pregnancy (prenatal) or during labor and delivery (perinatal) and there are a number of well-known causes.

Oxygen Deprivation

The primary cause of infant brain damage (during both pregnancy and childbirth) is lack of oxygen to the brain (asphyxia). Some degree of oxygen deprivation during pregnancy or delivery is surprisingly common. Asphyxia is reported in as many as 10 out of every 1,000 live births, according to data published in the American Journal of Neuroradiology. A large percentage of these cases are attributable to negligent prenatal or perinatal medical care.

There are 2 different categories of oxygen deprivation that can cause infant brain damage: hypoxia and anoxia. Hypoxia occurs when the supply level of oxygen to the baby's brain is significantly reduced but not completely cut off. Reduced oxygen levels to the brain can cause damage over a period of time but the extent of the injury tends to be less severe. Apoxia occurs when the delivery of oxygen to the baby is entirely cut off for some period of time. 

Without any oxygen at all, cells in the brain begin to decay and die within a matter of minutes. This type of total oxygen deprivation usually results in much more serious injuries to the brain. Both anoxia and hypoxia can cause permanent disabilities like cerebral palsy. Disruption of oxygen leading to either hypoxia or anoxia can be triggered by a number of different complications or health conditions during pregnancy or childbirth. Listed below are the most common reasons for infant oxygen deprivation during pregnancy or delivery:

  • Umbilical Cord Issues: until the baby is actually born and breathing on its own, oxygen is delivered from the mother through the umbilical cord. A variety of complications involving the umbilical cord can arise and potentially disrupt the supply of oxygen through the cord. If the umbilical cord becomes twisted, compressed, or pinched at any point during gestation or labor and delivery oxygen delivery can be disrupted or cut off entirely. Certain umbilical cord problems, such when the cord becomes twisted around the baby's neck or prolapses during delivery, are particularly dangerous and doctors only have a few minutes to respond before brain damage occurs.
  • Birth Canal Delays: during a vaginal delivery it is very common for babies to become stuck while passing through the birth canal. One of the most common instances of this occurrence is called shoulder dystocia. This is when the shoulder of the baby gets stuck behind the pelvic bone of the mother. When babies become stuck in the birth canal for too long they can be at risk of oxygen deprivation.
  • Placental Separation: complications involving the placenta can also trigger oxygen deprivation. For instance, if the placenta tears away from the uterus prematurely (a condition is known as placental abruption) oxygen supply to the baby can be disrupted particularly if the condition is not immediately managed.

When infant brain damage is the result of oxygen deprivation it is almost always something that occurs during pregnancy or during childbirth. However, other types of brain injuries can actually occur in the first days and weeks after the baby is born. The most common type of postnatal brain injury is related to newborn jaundice. Jaundice is a medical condition that occurs when levels of bilirubin in the blood become too high. Bilirubin is a yellowish byproduct of red cell replacement. Normally bilirubin is broken down by the liver, newborn babies have underdeveloped livers when they are first born which makes processing bilirubin more difficult. For this reason, high bilirubin levels are normal for newborns. 

Jaundice occurs when levels of bilirubin exceed healthy levels causing a yellow appears in the skin and eye whites. Because infant jaundice is so common and usually goes away on its own, it is generally perceived as a minor condition. The reality, however, is that certain cases of infant jaundice can very dangerous and cause a specific type of brain damage if left untreated. In severe cases of infant jaundice, bilirubin levels in the blood become so high that the bilirubin starts to invade brain tissue. When bilirubin infiltrates the brain it causes a rare but very serious type of brain injury called kernicterus.

Maternal Infection

Another significant cause of infant brain injury is a maternal infection. When not timely diagnosed and properly managed, infections in pregnant mothers can potentially interfere with the delivery of oxygen to the baby. The risk of brain injury varies depending on the particular type of viral or bacterial infection and the location of the infection. Chorioamnionitis is a bacterial infection in the fetal membranes (e.g., uterus & placenta) or the amniotic fluid. This type of infection can be particularly dangerous for the baby and if not promptly diagnosed and treated effectively it can cause damage to the baby's brain.

Delivery Trauma

Some brain injuries are the result of external head trauma suffered during a difficult vaginal delivery. The use of excessive force, pulling or lateral traction by doctors during delivery can occasionally result in damage to the brain. However, the most common cause of this type of brain injury involves the negligent use of birth-assistance tools such as obstetrical forceps or a vacuum extractor. When these tools are not used with the necessary level of skill and care they can cause external trauma to the baby's head. This external injury can result in swelling, hemorrhaging or other internal reactions that can damage cells and tissue inside the brain.