Neonatal Brain Injury
Common Neonatal Brain Injuries:
Brachial Plexus Injury
Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood.
Cerebral means having to do with the brain.
Palsy means weakness or problems with using the muscles.
CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles.
Neonatal encephalopathy (NE) is a syndrome that can occur in newborn babies in which neurological function is disturbed. The most frequent cause of NE is lack of oxygen to the baby at some point during pregnancy or birth.
When oxygen deprivation causes NE, the condition may be referred to as hypoxic ischemic encephalopathy (HIE).
Lack of oxygen causes damage to the brain, but it can also affect other internal organs. The heart, lungs, kidneys, liver and gastrointestinal system may all experience complications as a result of low oxygen. Babies who experience NE and survive are at high risk to go on to have permanent brain injury or cerebral palsy, but immediate treatment can improve outcomes.
In some cases, NE can be caused by other factors such as:
An infection in the mother’s uterus (womb) before birth
An intraventricular hemorrhage (a type of bleeding in the brain that can be associated with prematurity)
A congenital brain malformation
A genetic or metabolic disorder
A newborn with neonatal encephalopathy may experience the following immediately after birth:
Subnormal level of consciousness
Seizures (Riley Hospital for Children, 2021)
Brachial Plexus Injury
The brachial plexus is a complex network of nerves between the neck and shoulders. These nerves control muscle function in the chest, shoulder, arms, and hands, as well as sensibility (feeling) in the upper limbs.
Brachial plexus birth injury, also known as brachial plexus injury, is an injury to the brachial plexus nerves that occurs in about one to three out of every 1,000 births.
The nerves of the brachial plexus may be stretched, compressed, or torn in a difficult delivery. The result might be a loss of muscle function, or even paralysis of the upper arm.
Injuries may affect all or only a part of the brachial plexus:
Injuries to the upper brachial plexus (C5, C6)
affect muscles of the shoulder and elbow.
Injuries to the lower brachial plexus (C7, C8, and T1)
can affect muscles of the forearm and hand (Boston Children's Hospital, 2021).
Erb's palsy is generally caused by traction (stretching) of the nerve fibers of the brachial plexus when the head and shoulder are moved in opposite directions. This may occur following delivery of the head when the head is deviated away from the shoulder so that the shoulder can clear the birth canal (i.e., shoulder dystocia).
This type of brachial plexus injury also follows cesarean section deliveries, indicating that it is not simply an indication of a poorly performed delivery.
Reported risk factors include large infants, small mothers, low or midforceps delivery, vacuum extraction, second-stage labor exceeding 60 minutes, and delivery of a previous infant with an obstetric brachial plexus injury (American Association of Neuromuscular & Electrodiagnostic Medicine, 2021)
During labor or birth, pressure on a baby's face may injure the facial nerve. This may also occur when forceps are used for delivery. The injury is often seen when the baby cries. There is no movement on the side of the face with the injury and the eye can’t be closed. If the nerve was only bruised, the paralysis usually improves in a few weeks. If the nerve was torn, surgery may be needed (Stanford Children's Health, 2021).