Despite a healthy pregnancy, inadequate blood supply to a baby's brain during delivery can cause devastating damage to the infant. A new study suggests that maternal anxiety over delivery room mishaps — the focus of many medical malpractice lawsuits — is misplaced. The vast majority of babies born with severe brain damage are not the result of mismanaged deliveries, say Loyola University Medical Center researchers, instead, the damage may be from difficult-to-detect infections and anemia.
The researchers, led by Dr. Jonathan Muraskas, a professor in the department of pediatrics, say their results support closer scrutiny of the first two hours following birth for possible causes of non-preventable neurological damage in newborns.
Between one and three infants out of every 1,000 full-term newborns experience encephalopathy, an umbrella term for diseases in the brain that are marked by impaired levels of consciousness, seizures, difficulty breathing, and depressed reflexes. Static encephalopathy, or cerebral palsy, is caused by birth injuries that affect the central nervous system. Cerebral palsy affects less than 1 percent of children. Past studies have found that only 8 to 14.5 percent of all encephalopathy cases are due to inadequate blood supply to a baby’s brain during delivery, however, this tragic result is a leading cause of allegations and lawsuits against obstetricians.
For the study, Muraskas and his colleagues examined the medical records of 32 full-term infants who developed severe cerebral palsy and mental retardation, including 18 newborns with chorioamnionitis, inflammation of the fetal membranes due to a bacterial infection, and 14 newborns with severe anemia.
Healthy pregnancy or just the appearance of one?
Both conditions are difficult to detect prior to birth. Chorioamnionitis is caused when bacteria infect the amniotic fluid and the membranes surrounding the fetus. Anemia results from an insufficient amount of blood in the baby after birth.
Based on their examination of the records, Muraskas and his colleagues say the gases in the umbilical cord blood were normal, and there was little injury to the brains' deep gray matter. These indicators strongly suggest the babies had not suffered brain damage before birth. Once born, though, the babies were unable to cope with their infections or anemia on their own.
Severe cases of chorioamnionitis and anemia can impede delivery of oxygen to the brain and other vital organs. In such circumstances, even the best resuscitation efforts are unable to prevent severe brain damage. The records included in this study indicate proper resuscitation had been performed.
Another possible cause of brain damage? Babies infected by chorioamnionitis often develop sepsis, an extreme response to infection that causes tissue damage and organ failure.
“All too often in cases of professional liability, the focus is on the last two hours of a normal 7,000-hour term pregnancy," the researchers wrote. Instead, it is the presence of chorioamnionitis or fetal anemia that often results in "devastating outcomes,” despite appropriate obstetrical and pediatric-neonatal care.
Source: Muraskas JK, Kelly AF, Nash MS, Goodman JR, Morrison JC. The role of fetal inflammatory response syndrome and fetal anemia in nonpreventable term neonatal encephalopathy. Journal of Perinatology. 2016.