What Causes Cerebral Palsy?
Cerebral palsy may be the result of brain injury. It can be caused by two different types of brain damage.
The first type of brain damage occurs when a baby’s brain develops improperly. Genetic problems or poor maternal health may lead to improper development.
The second type is brain damage that takes place during labor or delivery. Brain damage at birth may occur when an illness or injury damages a brain that would have otherwise been unharmed. This type of brain damage may be an accident or the result of medical malpractice.
The location of the brain injury and the extent of the damage determines if your child will develop a permanent disorder like cerebral palsy.
Overall, cerebral palsy causes include:
- Improper care during labor and delivery
- Improper response to fetal distress
- Prolonged lack of oxygen to the baby’s brain
- Other types of medical negligence
Fetal distress often indicates a lack of oxygen to the baby’s brain. If the fetal distress is not corrected or responded to properly, it can cause permanent damage and conditions like cerebral palsy.
Research by the National Institute of Neurological Disorders and Stroke shows that delivery complications account for 5% to 10% of severe cerebral palsy cases in newborns.
Cerebral Palsy Etiology
Etiology is the study of the causes and origins of diseases. Cerebral palsy etiology is the study of how cerebral palsy starts and what causes it.
Cerebral palsy etiology begins by studying the effect of brain damage on an infant before they have finished growing. The brain is not fully developed at birth and continues to mature during the early months of life.
In the months before, after and during birth, the brain is delicate. The brains of premature babies are particularly fragile. If the parts of the brain that control movement are damaged, the baby may develop cerebral palsy. Further, a lack of oxygen to the brain or too much pressure on the brain may cause cerebral palsy.
Are Cerebral Palsy Causes Preventable?
The brain damage that causes cerebral palsy is often preventable, especially when it results from medical negligence.
Examples of medical negligence include:
- Improper response to infant’s distress
- Improper handling of a child during delivery
- Failure to properly manage problems with the placenta and umbilical cord
- Improper response to a medical emergency during delivery
When medical professionals fail to identify a serious illness in the mother or fetus, it may put the baby at risk of developing cerebral palsy. This is an example of medical negligence.
Further, when doctors and hospital staff misuse medical tools or rush during the delivery, it can lead to conditions like cerebral palsy. This is also considered medical malpractice.
Cerebral Palsy from Physical Birth Injury
If your child has cerebral palsy resulting from birth injury, think back to the events in the delivery room. Were proper medical standards of care upheld?
The most tragic cause of cerebral palsy is a birth injury that could have been avoided by proper care.
Examples of improper care include:
- Misreading electronic fetal monitor strip
- Misreading sonograms
- Failure to detect a prolapsed umbilical cord that reduces oxygen supply
- Improper use of forceps or vacuum extractors
- Delaying a C-section
- Failure to perform a C-section
- Failure to detect lack of oxygen both during delivery and after birth
- Failure to detect or treat bleeding in the brain
- Failure to recognize or treat seizures
- Failure to provide a proper examination of the newborn
Brain Injuries and Cerebral Palsy
Cerebral palsy often arises due to an injury to the brain before, during or shortly after birth.
It is often associated with:
- Low levels of oxygen in the brain (hypoxia)
- Bleeding in the brain
- Brain infections
- Head injury
- Infections in the mother during pregnancy
- Severe jaundice
Cerebral palsy from brain injury is somewhat more common in:
- Boys than girls
- Multiple births than single births
- African-Americans than other ethnicities
Brain Injury Risk Factors
There are some circumstances that have been identified as common risk factors for developing cerebral palsy from brain injuries.
These risk factors include:
- Premature birth
- Very low birth weight
- Bleeding within the brain
- Brain trauma
- Complications of labor and delivery
- Viruses and infections during mother’s pregnancy
- Improper medical care or medical negligence
Although cerebral palsy from a brain injury can occur during the months before, during and after birth, the symptoms may not appear right away. If you notice that your baby is not meeting the common milestones of development, consult with your doctor. In some cases, missing these milestones could indicate that your child has cerebral palsy.
Brain Ischemia as a Cause of Cerebral Palsy
Brain ischemia occurs when a new baby’s brain does not get enough blood. Also called cerebral ischemia, it can happen before, during or after a baby’s birth.
When brain ischemia occurs, a blood clot or injury blocks the flow of blood within the brain. When this happens, pressure on certain areas of the brain can cause severe injuries. Sometimes, these brain injuries can lead to cerebral palsy.
The damage from brain ischemia cannot be reversed. When you see or hear “ischemia” in the delivery room or nursery, it might mean that your baby’s blood flow to the brain has decreased or stopped.
There are two major types of brain ischemia that can occur during pregnancy, delivery or shortly after birth.
- Focal Brain Ischemia: reduces blood flow to a particular area of the brain
- Global Brain Ischemia: spread throughout the brain and more severe
Both types of brain ischemia can be caused by improper medical care or medical negligence. If the injury leads to cerebral palsy, it could mean a lifetime of expensive treatments and therapies for your child.
How Brain Ischemia is Detected
In the delivery room, a fetal heart monitor records the baby’s heart rate and the contraction patterns of the mother. The readings from this monitor show the medical team information about the baby’s condition.
When brain ischemia occurs, the reading will indicate that the baby is in distress. Some possible signs of cerebral ischemia are seen as seizures, hypotonia, excessive crying, and irregular breathing.
Tests that can be done to diagnose brain ischemia include lab tests, MRI, and head ultrasounds.
Brain Damage at Birth
Infants may be at higher risk for brain damage at birth if they are born prematurely or if they have medical problems.
Medical problems that put babies at a higher risk for brain damage include:
- Bleeding in the brain
- Illness that caused them to go into shock
- Infections of the central nervous system
- Problems with the umbilical cord
- Problems with the placenta
- Interruptions in oxygen or blood flow to the brain
- Physical injuries
- Reduced blood circulation
- Reduced passage of oxygen and nutrients through body tissues
Some causes of brain damage, such as inherited disease, cannot be prevented. However, many incidents of brain damage at birth may have been prevented by proper medical care. If your child suffered brain damage at birth, it is important you understand what really happened during labor and delivery.
Premature Birth as a Cause of Cerebral Palsy
One of the most common effects of premature birth is respiratory distress syndrome (RDS). Immature lungs are inelastic and lack surfactant, which helps to keep the lungs inflated with air. The baby struggles for oxygen and breathing becomes too rapid.
When a baby is born fewer than 28 weeks into pregnancy, he or she may have an extremely low birth weight. When born prematurely, a baby will typically need to spend time in the neonatal intensive care unit. While there, medical teams may be able to watch for and treat RDS and potentially decrease the long-term effects of premature birth.
Common effects of premature birth include:
- Feeding immaturity
- Temperature instability
- Prolonged jaundice (a symptom of liver trouble)
- Language disorders
- Attention deficits
- Slower development
- Behavioral issues
- Chronic lung disease
- Mental retardation
Statistics About the Effects of Premature Birth
- For babies between 23 and 26 weeks, every extra day in the womb increases their chance of survival by 2% to 4%.
- About 9 out of 10 babies born at 28 weeks survive, but many of them have serious health problems, such as vision and hearing problems, feeding and digestive problems, respiratory problems or cerebral palsy.
- Babies born earlier than 23 weeks have a much smaller chance of survival, as they have not developed enough to survive on their own.
- Children born closer to term (34 to 36 weeks gestation) have fewer long-term effects of premature birth.
Birth Asphyxia as a Cause of Cerebral Palsy
Birth asphyxia is a scary term to hear from your health professional. Birth asphyxia, or perinatal asphyxia, is a lack of oxygen to the brain as a result of a difficult labor or delivery.
Causes of birth asphyxia include:
- Improper care or medical negligence by medical professionals
- Low iron in the mother’s blood (anemia)
- Reduction of blood flow between mother and baby
- Umbilical cord compression during birth
- Problems in the placenta
- Delivery complications that are not promptly or properly responded to
- Mother’s sedation during delivery
- Low birth weight
Birth asphyxia must be responded to promptly and accurately to prevent a birth injury. Failure to respond appropriately is medical negligence.
Brain injuries caused by birth asphyxia may lead to cerebral palsy. In fact, birth asphyxia causes 10% of all cerebral palsy cases.
Anoxia and Hypoxia During Childbirth
Cerebral palsy is often caused by the lack of oxygen to a baby’s brain. A common medical term for this condition is anoxia. Anoxia is a complete lack of oxygen. A related term, hypoxia, means a lack of adequate oxygen to all or part of the body.
Conditions related to anoxia and hypoxia include:
- Brain injury
- Cerebral palsy
- Heart disease
- Lung disease
- Sleep apnea
If anoxia or hypoxia occur during labor or delivery, medical professionals may still be able to prevent a birth injury like cerebral palsy. A serious birth injury may be prevented if doctors and hospital staff react to the situation promptly and accurately.
Cerebral hypoxia is a decrease of oxygen to the brain even though there is adequate blood flow.
Cerebral hypoxia causes include:
- A drop in the mother’s blood pressure
- Compression of the umbilical cord
- Abnormal position of the baby in the womb
- Problems with the placenta
- Rupture of the uterus
- Medical negligence or improper medical care
Brain cells can begin to die shortly after oxygen supply has been cut off. When this happens, a brain injury can occur. Sometimes, brain injuries from cerebral hypoxia lead to cerebral palsy.
If the medical team assisting in your delivery does not respond properly to an indication of cerebral hypoxia, it can be considered medical negligence.
Hypoxic Ischemic Encephalopathy
Hypoxic ischemic encephalopathy (HIE) occurs when a baby’s brain does not get adequate oxygen. It affects the whole brain and may take place during pregnancy, labor or delivery.
The effect of an HIE to an infant’s brain is similar to that of a stroke on an adult’s brain.
- Blood vessels in the brain are broken or blocked
- Blood cannot flow to cells where it is needed
- Blood can leak into brain tissue where it is not needed
- Brain cells do not get oxygen and nutrients to make energy
- Cells cannot get rid of waste chemicals
Neonatal Encephalopathy and Hypoxic Ischemic Encephalopathy
Neonatal encephalopathy (NE) is a similar condition that overlaps with hypoxic ischemic encephalopathy. However, the conditions have several notable distinctions.
The main differences between NE and HIE are:
- Neonatal encephalopathy does not always involve a hypoxic event. Examples of this include a maternal infection that was not treated appropriately or a neonatal stroke.
- Hypoxic ischemic encephalopathy usually starts during labor and delivery. When not corrected, it can set off a chain reaction that can sabotage a baby’s heartbeat, breathing, immune system, digestion and muscles.
- Hypoxic ischemic encephalopathy is a life-threatening emergency. It gets worse during the first hours of life.
Periventricular leukomalacia (PVL) involves the death of brain tissue around fluid-filled areas called ventricles. The condition creates holes in the brain and only affects infants.
Periventricular leukomalacia and cerebral palsy are more common in premature infants than in babies born full-term. This is because the area of the brain affected is less developed in premature infants, especially those born before 32 weeks.
The more premature a baby, the higher the risk is for periventricular leukomalacia. Premature babies who have intraventricular hemorrhage (IVH) are also at increased risk for developing periventricular leukomalacia.
There is no cure for periventricular leukomalacia. Babies who have the condition will need early and aggressive cerebral palsy treatment to increase their chances of survival and long-term mobility.
Meconium Aspiration Syndrome
During the labor and delivery process, babies can inhale a mixture of meconium and amniotic fluid. If this happens, it can lead to a serious birth injury known as meconium aspiration syndrome.
Meconium is feces that is passed by the infant while still in the womb. It is recognized by a greenish tint to the amniotic fluid.
Meconium aspiration syndrome can block an infant’s airways after birth and cause breathing problems due to inflammation in the lungs.
Breathing complications can include:
- Aspiration pneumonia
- Brain damage due to lack of oxygen
- Breathing difficulty that lasts for several days
- Collapsed lung
- Inability to get enough blood into the lungs to take oxygen to the rest of the body
Symptoms of Meconium Aspiration Syndrome
Meconium aspiration syndrome can lead to severe illness in newborns and even death. Symptoms include swelling in the baby’s lungs, limpness, bluish skin coloring, and rapid breathing patterns.
Prevention of meconium aspiration syndrome is possible with careful monitoring. The moments and days after birth are a critical time for newborns because they need a constant flow of oxygen to their brains and nerves. A lack of oxygen to a newborn can lead to brain damage and cerebral palsy.
Alcohol and Cerebral Palsy
Alcohol has immense damaging effects to a developing fetus. Pregnant women should be advised against drinking alcohol until their baby is born.
Health professionals everywhere link a mother’s drug and alcohol use to many irreversible conditions. They often link cerebral palsy and alcohol use because alcohol has been proven to cause brain injuries.
Alcohol is a central nervous system depressant. It temporarily slows down reflexes, impairs concentration and reduces coordination. With long-term use, alcohol can damage the fetal brain and even shrink it in size.
Chronic effects of alcohol cause a vitamin deficiency. Vitamins are very important to the development of an unborn baby.