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Neurologic Injury in Newborns

Victor Lewin - Wednesday, September 20, 2017

To be successful in birth trauma litigation, it is necessary to prove, on a balance of probabilities, the cause of and/or material contribution to the infant’s neurologic or brain injury. While the plaintiff must also prove a breach of the standard of care, at least in birth trauma cases, the first step is often to establish causation with the lawyer.

Though proving the mechanism and timing of injury in newborns is a complex task that involves expert medical input from various specialties, early neuroimaging can provide vital information about the pattern of the brain injury and the areas of the brain affected. This helps to distinguish between chronic and acute injury, and can narrow the window of timing within which the injury occurred. Proving the timing of injury requires an evaluation of antenatal (pre-birth), peripartum (during birth) and neonatal information.

Neuroimaging, such as magnetic resonance imaging (MRI), performed very shortly after birth can identify lesions with recent onset and can be used to approximate the timing of when injury occurred to the newborn brain, thereby excluding antenatal or genetic causes of injury. By revealing the pattern of injury and affected areas of the brain, the likely timing and mechanism of injury can be sufficiently narrowed to help prove causation on a balance of probabilities.

For instance, the pattern of brain injury revealed by MRI provides information regarding the mechanism of injury. The injury may be diffuse throughout the brain or one hemisphere, or alternatively, focal to discrete areas in one or both hemispheres of the brain. The pattern and mechanism of injury provide information that may help to narrow the timing of when the injury, or contribution to the injury, occurred, and thus prove its cause, on a balance of probabilities.

Hypoxia-ischemia - brain damage that occurs when an infant’s brain doesn’t receive enough oxygen and blood - displays a pattern of brain imaging of injury that is mostly diffuse and bilateral. It can be caused by intermittent repetitive interruptions of oxygen supply to the brain, or with a more profound interference. It is a neurologic injury commonly seen in birth trauma cases, and in some cases, may be caused by mismanagement of labour, or other negligence and inadequate care in or around the time of birth. Hypoxia-ischemia is associated in the medical literature with a metabolic acidosis in cord blood, though it may occur without.

Infant neurologic injury may also be focal – meaning that a defined, rather than diffuse, area of the brain is affected. Such injuries are strokes and may also be accompanied by metabolic acidosis or fetal hypotension (low blood pressure). Though not as well documented in the medical literature pertaining to mismanagement of labour and delivery, strokes and focal neurologic injury may also be attributed to lack of oxygen to the brain, and negligence during labour and delivery.

While acknowledging the importance of other clinical and diagnostic evidence, neuroimaging of the infant brain, along with fetal heart rate data, is essential to establishing acute injury, and is crucial to the causation analysis. Learn more with Wagners’ team of lawyers in Halifax.

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