Brad Bradshaw, M.D., J.D., L.C



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Types of Birth Injuries


Cerebral Palsy

Cerebral palsy is actually a group of disorders that can involve brain and nervous system functions including movement, learning, hearing, seeing, and thinking.

There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed.

Symptoms

Symptoms of cerebral palsy can vary greatly, and can range from very mild to very severe. Symptoms can also affect either one or both sides of the body, and be more pronounced in the arms or legs, or involve both the arms and the legs. Children with cerebral palsy usually start to display symptoms before the age of 2 years. Sometimes symptoms can begin immediately after birth. Seizure activity is often a "hallmark" of the injury.

Symptoms can include:
  • Hypertonic (excessively stiff) or hypotonic (excessively floppy) muscles
  • Developmental delays (rolling, sitting, crawling, walking) or poor motor skills
  • Difficulty sucking or feeding in infants, or difficulty chewing or swallowing in adults – sometimes requiring a feeding tube
  • Seizures
  • Problems with vision, hearing or speech

There are many other symptoms that can occur, depending on the type of cerebral palsy. If your child exhibits any or all of these symptoms, or any additional symptoms, you should seek a medical opinion and diagnosis as soon as possible.

Possible Causes & Risk Factors

Cerebral palsy is caused by injuries or abnormalities of the brain. These problems can occur as the baby grows in the womb or at any time during the first 2 years of life when the baby's brain is still rapidly growing and developing. In some individuals with cerebral palsy, parts of the brain have been injured due to low levels of oxygen (hypoxia) in that area of the brain. This low level of oxygen during birth (hypoxic ischemic encephalopathy) is one of the more common forms of cerebral palsy caused by birth injury from obstetric and/or hospital malpractice. Essentially, there is a failure to timely deliver the baby in an increasingly urgent then emergency situation.

In some cases, there are early warning signs during delivery and the emergency situation could have been prevented entirely. In others, a timely c-section would have prevented the injury.

Premature infants have a higher risk of developing cerebral palsy. Cerebral palsy can also come about during delivery and early infancy as a result of other conditions, including:

  • Bleeding in the brain (especially with vacuum or forceps delivery)
  • Brain infections (encephalitis, meningitis, herpes simplex infections)
  • Head Injury
  • Infections in the mother during pregnancy (rubella)
  • Severe jaundice

Treatment

While there is currently no cure for cerebral palsy, there are treatments available to help the person be as independent as possible.

Proper treatment usually requires a team of specialists, including doctors, nurses, attendant care specialists, dentists, social workers, therapists (occupational, physical and speech), neurologists, pulmonologists and gastroenterologists. Treatment also includes education in self and home care. Many individuals with cerebral palsy also eventually require the assistance of different types of medical equipment and devices, including glasses, hearing aids, muscle and bone braces, walking aids and/or wheelchairs.

Over the course of an individual's lifetime, these costs can be substantial. Dr. Bradshaw has a proven track record of helping clients find out what went wrong and getting children the compensation they need to provide the best possible life and medical care for their loved ones. Dr. Bradshaw works with life care experts across the country to accurately determine the costs of treatment during a person's lifetime.

Defenses

Obstetricians, in conjunction with insurance companies, defense attorneys and some pediatricians, wrote a book called "Obstetrics & Gynecology (Green Journal)". This publication was written to help defend these specific type of medical malpractice cases. It sets forth criteria which must be met before a cerebral palsy/birth injury from malpractice at delivery can be proven. The studies used by this publication do not even support the authors' conclusions; and, in most cases, in order to meet the criteria, the infant would be deceased. Here are the "requirements" from this book:

Essential criteria (must meet all four)

  1. Evidence of a metabolic acidosis in fetal umbilical cord arterial blood obtained at delivery (pH <7 and base deficit =12 mmol/L)
  2. Early onset of severe or moderate neonatal encephalopathy in infants born at 34 or more weeks of gestation
  3. Cerebral palsy of the spastic quadriplegic or dyskinetic type†
  4. Exclusion of other identifiable etiologies such as trauma, coagulation disorders, infectious conditions, or genetic disorders

Criteria that collectively suggest an intrapartum timing (within close proximity to labor and delivery, eg, 0-48 hours) but are nonspecific to asphyxial insults

  1. A sentinel (signal) hypoxic event occurring immediately before or during labor
  2. A sudden and sustained fetal bradycardia or the absence of fetal heart rate variability in the presence of persistent, late, or variable decelerations, usually after a hypoxic sentinel event when the pattern was previously normal
  3. Apgar scores of 0-3 beyond 5 minutes
  4. Onset of multisystem involvement within 72 hours of birth
  5. Early imaging study showing evidence of acute nonfocal cerebral abnormality

Source: http://www.acog.org/from_home/Misc/neonatalEncephalopathy.cfm
Source: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/
August 2011

Sample Life Care Plan (link to plan)



Brachial Plexopathy

(Also called brachial plexus; Erb's Palsy; Brachial plexus dysfunction; Parsonage Turner syndrome)

Brachial plexopathy is a form of peripheral neuropathy that causes pain, decreased movement and/or sensation in the arm and shoulder.

Symptoms

  • Deformity of the arm or hand
  • Difficulty moving the shoulder, arm, hand, or fingers
  • Diminished arm reflexes
  • Wasting of the muscles
  • Weakness of hand flexing
  • Numbness of the shoulder, arm, or hand
  • Shoulder pain
  • Tingling, burning, pain, or abnormal sensations
  • Weakness of the shoulder, arm, hand, or wrist

If your child exhibits any or all of these symptoms, or any additional symptoms, you should seek a medical opinion and diagnosis as soon as possible.

Causes

Brachial plexopathy occurs when there is damage to the brachial plexus, an area where a nerve bundle from the spinal cord splits into the individual arm nerves. This is usually a result of direct injury to the nerve. It can also be associated with birth defects, exposures to toxins or drugs, or inflammatory conditions due to a virus or immune system. Malpractice due to improper use of forceps, vacuum or attempting to deliver a baby that is too large for the birth canal are known causes of brachial plexus injury (Erbs Palsy).

Treatment

The main goal of treatment is to correct the underlying cause and regain as much use of the arm and hand as possible. Therapy can include physical therapy; orthopedic devices such as braces, splints or other appliances; vocational or occupational therapy; medications, and in some cases, surgery. If there is a complete avulsion of the nerve root, surgery is more likely to be needed.

Treatment is aimed at correcting the underlying cause and allowing you to use your hand and arm as much as possible. In some cases, when there is no avulsion of the nerve root but rather a stretching injury, no treatment is required and recovery happens on its own.

Source: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002391/
August 2011

Spinal Injuries:

Excessive traction or rotation during delivery can result in serious spinal cord injuries to infants. The use of mechanical devices such as forceps or vacuums can increase the risk of these types of injuries. Other risk factors include breech deliveries, infants with high birth-weights, and abnormal or excessive traction during delivery. These risks can be diminished by an appropriately timed cesarean delivery.

Cases where the upper cervical cord or lower brain stem suffered injury can result in still-birth or neonatal death if adequate respiratory function is not established.

According to some studies, nearly half of all birth traumas are avoidable. Proper recognition and anticipation can greatly reduce the risk of a child suffering a permanent injury or death.

Source: http://emedicine.medscape.com/article/980112-overview
August 2011

Vacuum or Forceps Deliveries:

Vacuum and forceps delivery are often causes of brachial plexus injuries, spinal cord injuries and cerebral bleeds resulting in cerebral palsy (HIE) or death.




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