Intracranial Hemorrhages in Newborns: Causes, Symptoms, and Treatment

Also known as a brain bleed, an infant intracranial hemorrhage is a birth injury that can vary from mild to extremely serious. Brain bleeds can be the result of oxygen deprivation near the time of birth (birth asphyxia ) or injuries due to excessive force on the infant’s head (birth trauma). In most instances, these complications arise due to medical negligence. The prompt diagnosis of intracranial hemorrhages is essential to administering appropriate treatment and limiting the severity of the injury. 

Types of Brain Bleeds

There are two different kinds of brain bleeds: inside the brain (intracranial) and outside of the brain (extracranial). 

Intracranial Hemorrhages

A ruptured blood vessel can cause bleeding in the brain, also known as a hemorrhagic stroke. This deprives brain cells of nutrients and oxygen. A hemorrhagic stroke can also lead to swelling, irritation, and pressure buildup and can also cause neonatal brain injuries. Hemorrhagic stroke usually takes one of two forms:

• Intracerebral hemorrhage: Also called a cerebral hemorrhage, this form of brain bleed originates from blood vessels in the brain.
• Subarachnoid hemorrhage: This type of brain bleed occurs between the two innermost membranes that encompass the brain, known as the subarachnoid space.  

Other types of intracranial hemorrhages include:

Intraventricular hemorrhage: This is a serious intracranial hemorrhage that takes place when there is bleeding in the brain’s ventricular system. This is where cerebrospinal fluid is created. It is most often seen in premies and newborns with very low birth weight since the blood vessels in their brains have not been able to finish developing, which makes them weaker. Birth trauma and oxygen deprivation can also be contributing factors. 

Subdural hematoma or subdural hemorrhage: This happens when one or more blood vessels in the subdural space rupture. The subdural space is the space located between the arachnoid membranes and the surface of the dura. These ruptures are commonly the result of a traumatic injury, such as birth trauma. 

Extracranial Hemorrhages

Common forms of extracranial hemorrhages include:

• Caput succedaneum: This is the name given to the swelling of a newborn’s scalp, which could hemorrhage. The swelling extends past the suture lines and typically occurs when an infant has undergone vacuum extraction or was in the birth canal for an extended period of time. 
• Cephalohematoma: Cephalhematomatic brain bleeds can be identified by bleeding between the skull and the skull’s covering. It is caused by ruptured blood vessels. Cephalohematomas present as a lifted bump on the infant’s head. They are usually caused by vacuum extraction or forceps injuries. Cephalohematomas tend to heal on their own but should be monitored by a medical professional to ensure that complications such as jaundice and anemia do not develop. 
• Subgaleal hematoma: These develop when blood collects in the space between the periosteum and the aponeurosis (the scalp and the skull) where the connective tissue is loose. 

Symptoms and Signs of Intracranial Hemorrhages

The symptoms of a brain bleed in a newborn will vary depending on the severity and type of bleed but often include:

• Apnea
• Neonatal seizures 
• Lethargy
• Difficulty feeding
• Abnormal tone
• Bulging soft spot
• Strained or shallow breathing
• Irritability
• Altered level of consciousness

Causes and Risk Factors of Intracranial Hemorrhages

Common causes of and risk factors for intracranial hemorrhages in newborns include:

• Macrosomia: A condition that develops during pregnancy in which the fetus is bigger than average for its gestational age, making vaginal birth hazardous.
• Cephalopelvic disproportion: A condition similar to macrosomia, except it refers specifically to a mismatch in size between the mother’s pelvis and the baby’s head.   
• Abnormal fetal presentation: This occurs when an infant is born in the brow, face, or breech presentation.
• Hypoxic-ischemic encephalopathy: This is a dangerous neonatal brain injury caused by reduced blood flow and oxygen to the infant at or close to the delivery. Insufficient blood flow leads to cell death and the breakdown of blood vessel walls, which in turn causes bleeding. 

Some additional risk factors are:

• Trauma caused by prolonged labor
• Anomalous changes in blood pressure
• Blood disorders like hemophilia or vitamin K deficiency

If any of these risk factors for intracranial hemorrhage are observed, doctors need to closely monitor the infant for any indications of fetal distress. The likelihood of a C-section birth should also be discussed with the mother. If fetal distress is detected and normal delivery methods are unsuccessful, an emergency C-section will be necessary to reduce the risk of intracranial hemorrhage as well as other serious birth injuries. 

Unfortunately, serious brain and head trauma to babies can also be caused by medical intervention in labor and delivery, such as:

• Vacuum extractors and Forceps: Incorrect or unnecessary use of delivery instruments such as vacuum extractors and forceps is a well-known cause of intracranial bleeding in newborns. 
• Delivery techniques: Inappropriate delivery techniques, such as traumatic breech delivery or excessive pulling or twisting of the baby’s head, can lead to serious intracranial hemorrhaging. 

In addition, premies are at a greater risk of intracranial hemorrhages because their underdeveloped blood vessels are so fragile. For this reason, it is vital that healthcare professionals do everything they safely and reasonably can to prevent premature births and deliver premature babies as safely as possible. 

Treating Intracranial Hemorrhages in Newborns

Treatment of brain bleeds in newborn babies is mostly supportive, although neurosurgical intervention might be required for certain types. The prognosis of a brain bleed will vary based on the location and severity of the bleed. Some babies do fare quite well with little to no lasting impacts. More serious brain bleeds, however, can cause physical and mental impairments such as cerebral palsy, learning disabilities, and developmental delays. Promptly and properly diagnosing an intracranial hemorrhage is critical. The sooner a newborn is diagnosed, the sooner therapy and treatment can be administered. 

Seeking legal assistance for an intracranial hemorrhage in a newborn is the most important step you can take to ensure the best life possible for your child. Collecting financial compensation via a medical malpractice lawsuit will make it possible for you and your family to pay for the treatments, therapy, medical equipment, lifestyle adjustments, and home care your child may require.  The Dallas birth injury attorneys at Rasansky Law Firm specialize in birth injury cases, including intracranial hemorrhages. Our experience lets us take on complex birth injury cases caused by a variety of medical errors and complications. , 

If your child was subjected to an intracranial hemorrhage during birth, our lawyers can review your case, determine if negligence was involved, pinpoint all liable parties, and discuss your legal options. We offer a free initial consultation and can advise you on how to best proceed with your birth injury case. Call us at (214) 617- 1886 to schedule your free consultation.