What Causes a Baby to Be Born with Brain Damage?
Patricia McGuire MD FAAP
It was supposed to be a happy time. Their baby was born. But something went wrong. The baby wasn't active at birth and didn't cry for a while. You noticed that his skin was pale. He wasn't breathing well. Finally, your doctor sits down with you and tells you that your beautiful newborn was born with a brain injury due to a lack of oxygen.
How could that happen? Did you do something wrong during pregnancy? Did something go wrong during labor? Is someone responsible for this?
These are critical questions to ask. First, let's define two terms.
Hypoxia – Hypoxia is when the fetus doesn’t get enough oxygen. Oxygen problems can occur anytime during pregnancy, labor, or delivery.
Asphyxia – Oxygen to the baby is blocked. This happens during labor or delivery.
What are the causes of infant asphyxia?
Asphyxia occurs during labor and delivery when the baby is ready to take his first breath. Unfortunately, there is a problem with getting oxygen to the infant.
The most common causes of infant asphyxia are:
- The mother’s blood is low in oxygen
- The mother has high or low blood pressure problems
- The umbilical cord is squeezed by a knot, the cord wraps around the infant's body or neck, or the cord is prolapsed or squeezed between the infant and the uterus
- The stressed fetus inhales a combination of amniotic fluid and meconium (baby's first bowel movement) during labor or delivery. This is called meconium aspiration syndrome.
- Babies born before 37 weeks are premature. They can’t breathe well due to underdeveloped lungs.
- In an amniotic fluid embolism, a rare and severe condition, amniotic fluid enters the pregnant mother's bloodstream and causing an allergic reaction.
- The uterus ruptures
- The placenta separates from the uterus
- The mother has an infection during labor
- Labor is prolonged or difficult
What are the risk factors that could lead to asphyxia?
Many risk factors can be due to maternal issues:
- Being between the ages of 20 and 25 years
- Multiple births such as twins or triplets
- Little or no prenatal care
- Low infant birth weight
- Abnormal fetal position during delivery
- Pre-eclampsia or eclampsia
- History of birth asphyxia in a previous birth
What are the causes of infant hypoxia?
Other than asphyxia, some factors can lead to oxygen problems in the newborn. These low blood oxygen levels are present throughout most of the pregnancy. Three categories of factors explain this:
- Both the mother and her fetus are hypoxic. Reasons include living in high altitudes, maternal heart disease, maternal anemia, infections, or pulmonary hypertension. The fetus is at a higher risk for hypoxia if the mother has chronic inflammatory conditions, such as diabetes, cancer, arthritis, and bowel diseases like Crohn's disease and ulcerative colitis.
Maternal smoking is a preventable cause of hypoxia. Cigarettes have various adverse effects on the developing fetus due to a build-up of carbon monoxide.
- Placenta hypoxia is when the mother has plenty of oxygen, but the circulation between the uterus and the placenta is damaged. Examples are placental insufficiency, poor placental placement on the uterus, or pre-eclampsia.
- Only the fetus is hypoxic. Fetal diseases can have a direct impact on fetal oxygenation. An example would be congenital heart disease, affecting one infant in every hundred births. Other reasons listed before include umbilical cord prolapse and problems with the uterus or placenta during delivery.
How do physicians monitor for possible brain oxygen issues in the fetus?
The type of monitoring of the pregnant mother and her fetus changes over time. You should expect to be cared for is as follows:
- Prenatal and neonatal care – Excellent care before, during, and after birth is essential in preventing oxygen distress, especially in high-risk pregnancies.
- Prenatal testing – Doctors use several tests to confirm the baby's well-being, identify risk factors, and alert the doctor about possible oxygen-depriving events.
- Fetal heart rate monitoring – This machine keeps track of fetal heart rate and rhythm noting changes that show fetal stress, which can be due to low oxygen.
- Preventing premature birth – Premature infants’ lungs aren't developed enough to get the oxygen they need from the air. Physicians use different methods to keep labor from continuing.
- C-section delivery – Doctors perform C-sections if the fetus is at risk for asphyxia or death.
Will the brain damage be permanent?
Hypoxia and asphyxia cause damage, ranging from mild to severe. Brain damage severity depends on the reasons for the hypoxia, as well as the length of time your fetus was without oxygen. Mild damage followed up with early services such as physical and occupational therapy, and speech therapy may correct these problems. The following are some of the possible issues your infant may have as he gets older:
- Cerebral palsy
- Developmental delays, including cognitive impairment
- Learning, language, and attention problems
- Motor disorders
- Hearing problems
- Eyesight problems
How can infant brain injuries be prevented?
Infant brain injuries will always be a risk. However, you can lower the risk through the following actions:
- Stop smoking
- Start with prenatal care early
- Follow your doctor's guidance on medications, your chronic health problems, rest, and nutrition.
- Tell your doctor right away if something doesn't seem right with your unborn baby, such as a lack of movement for longer than expected or spotting or bleeding.
The healthier you stay during your pregnancy, the better your chances for a healthy infant.
fetal hypoxia. (n.d.) Medical Dictionary. (2009). Retrieved February 9, 2022, from https://medical-dictionary.thefreedictionary.com/fetal+hypoxia
asphyxia. (n.d.) Farlex Partner Medical Dictionary. (2012). Retrieved February 9, 2022, from https://medical-dictionary.thefreedictionary.com/asphyxia
International Journal of Pediatrics, Volume 2010, Article ID 401323, 9 pages doi:10.1155/2010/401323
Morales, P., Bustamante, D., Espina-Marchant, P. et al. Pathophysiology of perinatal asphyxia: can we predict and improve individual outcomes? EPMA Journal 2, 211–230 (2011). https://doi.org/10.1007/s13167-011-0100-3
Moshiro Robert, Mdoe Paschal, Perlman Jeffrey M., A Global View of Neonatal Asphyxia and Resuscitation, Frontiers in Pediatrics, VOLUME 7, 2019