Nerve Injuries in Newborns
February 7, 2018
Nerve injuries—minor or life-threatening—may occur pre-delivery or during delivery. These nerve-related birth injuries typically cause weakness of the muscles controlled by the affected nerve. Nerve injuries symptoms may be observed through:
- A lopsided facial expression, resulting from facial nerve damage, or facial palsy
- Arm and/or hand weakness, called Brachial plexus nerve damage
- Difficulty breathing, called Phrenic nerve damage
- Paralysis, known as spinal cord damage which is very rare
When a newborn cries, and the face appears lopsided (asymmetric), a facial nerve injury may be suspected, such as facial palsy. This loss of controllable (voluntary) muscle movement in an infant’s face is usually due to pressure on the facial nerve in the face just before or at the time of birth. Facial nerve weakness can be temporary or permanent, and symptoms may persist throughout the life of the child into adulthood. The cause of this nerve injury may include:
- The fetus position in the uterus before birth
- The facial nerve is pressed against the mother’s pelvis during delivery
- Improper use of forceps to assist the delivery
The large group of nerves between the neck and shoulder, leading to each arm is called the brachial plexus. Neuropraxia is the mildest form of brachial plexus injury which involves the stretching of the nerve. A neuroma is more severe—where the nerve is torn and does not heal properly. Rupture involves the tearing of the nerves, yet they remain attached to the spine. An avulsion is the most severe condition of brachial plexus—where the nerve roots are completely dislodged from the spine, creating complete paralysis. One or both of the baby’s arms, during a difficult delivery, can be improperly stretched, injuring the nerves of the brachial plexus, causing weakness or paralysis of part or all of the infant’s arms and/or hands. When there is a weakness of both the shoulder and elbow, this nerve damage is called Erb palsy. When nerve damage results in a weakness of the hand and wrist, it is called Klumpke palsy. Brachial plexus injuries are related to difficult deliveries, typically involving large babies who should’ve been delivered via C-section (caesarian), and not vaginally.
When Brachial plexus birth injuries are suspected, recommendations state to heal the nerves, extreme movements at the shoulder should be avoided. Milder injuries resolve over a few days, however, if the abnormality is more severe or lasts for more than 1 or 2 weeks, proper positioning and gentle movement of the arm through physical therapy or occupational therapy is strongly advised. Doctors urge parents that if there is no improvement over a 1-2 month period, a pediatric neurologist and/or orthopedist at a pediatric specialty hospital should evaluate the baby to decide whether surgery may be beneficial for future movement.
The nerve traveling to the diaphragm (the muscular wall that separates the organs of the chest from those of the abdomen and assists in breathing), is called the phrenic nerve. When this nerve is damaged, it results in the same-side paralysis of the diaphragm. The newborn may exhibit difficulty in breathing and sometimes, may require assistance with breathing.
Spinal cord injuries, a result of overstretching during delivery, are rare. In breech deliveries (born bottom-first instead of head-first), the lower cervical and upper thoracic regions of the spinal cord are the most likely to be injured. Spinal cord damage may occur when there is a blunt force trauma that affects the spine. This manifests in the form of a bruise (a contusion) or even a complete tear (a transection). Spinal cord damage can also come from a lack of diagnosis or misdiagnosis of spina bifida, a condition where the vertebrae doesn’t completely enclose the raw nerves of the spine. An infant with spina bifida –especially myelomeningocele—the nerves of the spinal column are at risk of injury, especially when the medical staff touches or damages the nerves because they are unaware of the condition. Nerve damage resulting from a spinal cord injury may result in paralysis below the specific site of the injury and are often permanent. In general, the higher up in the spine that the injury occurs, the more serious the damage will be. Spinal cord injuries that occur high up in the neck can be fatal because they prevent the newborn from breathing properly.
Cerebral Palsy is one of the most common causes of brain disorders affecting infants in the United States. According to the CDC, it affects around 4 children out of every 1,000 children. How these deficiencies affect the individual will vary depending on what type of disorder the person has. Cerebral palsy is often used as an umbrella term, but there are several different types, each with unique characteristics.
Knowing the type is important in finding the right treatment and therapy to improve mobility and independence:
- Spastic- This is the most common type that includes stiff muscles that may become weak or paralyzed, which can affect the ability to walk.
- Athetoid- This form may result in rigid, involuntary movements as well as overactive facial muscles.
- Ataxic- This condition is unique as it affects balance and coordination more than movement. It may result in speech problems, abnormal walking, tremors, and vision problems.
- Mixed- A result of more than one type of cerebral palsy resulting in any combination of symptoms.
Children affected by cerebral palsy may have difficulty walking or speaking. They may experience tremors, seizures, involuntary movements, or lack of muscle coordination. The child’s symptoms may be less noticeable or show up in the form of delayed milestones such as sitting up and crawling, excessive drooling, difficulty swallowing, or muscle tone that feels too floppy or too stiff.
Cerebral Palsy means there is a partial dormancy or paralysis of a baby’s brain. In many cases, the baby’s hearing, touch sensation, and vision are also affected. Cerebral palsy develops as a result of brain malformation before, during, or shortly after birth. However, the vast majority of cerebral palsy cases occur just before or during childbirth.
There can be many causes for cerebral palsy, but some of the more common causes include:
- Lack of oxygen to the brain during childbirth
- Maternal infections
- Labor complications such as a breech birth
- Bleeding into the brain
- Head injuries
When medical professionals fail to take the necessary precautions, fail to diagnose a condition, or fail to treat a condition that another doctor would have caught; the subsequent Cerebral Palsy diagnosis could be the result of medical malpractice. To help gain the answers and compensation you deserve, call Potter Burnett Law today to discuss your next steps.