Intracranial Hemorrhage

• Birth Complications
• Intracranial Hemorrhage

What is an Intracranial Hemorrhage, or Brain Bleed?

A neonatal intracranial hemorrhage (ICH) or brain bleed is a birth injury that may occur during childbirth, resulting in bleeding inside the baby’s brain. In this birth complication, the tearing of blood vessels within the baby’s brain causes the blood to spread to other parts of the brain tissue. Initial symptoms may be subtle, and the medical team assisting with the labor and delivery should be trained to detect, prevent, and minimize brain bleeds.

Babies who have suffered hypoxic-ischemic encephalopathy (HIE) around the time of birth are likely to have intracranial hemorrhages. Both HIE and/or ICH put the baby at an increased risk of cerebral palsy. Long-term complications may include hemiplegia (paralysis in one side of the body), ataxia (loss of muscle control), developmental delays, and cerebral palsy.

Brain bleeds may occur when the obstetrics team makes poor choices during labor and delivery, resulting in brain damage to the baby. When a medical provider fails to properly monitor a high-risk pregnancy where premature delivery was a distinct possibility or fails to recommend a cesarean section when it was the best course of action available especially in the face of fetal distress, the resulting neonatal intracranial hemorrhage may constitute medical malpractice.

Negligent use of forceps or vacuum extraction during an assisted vaginal delivery, failure to diagnose or treat umbilical cord complications, failure to react to fetal distress during labor or delivery, or incorrect handling of breech baby during delivery could be other forms of medical negligence leading to the baby’s brain bleeds.

Types of Neonatal Intracranial Hemorrhages

Neonatal ICH can be classified according to the location of the brain bleed. The amount of bleeding and the location where it occurs will determine the extent of brain damage the baby may suffer. Major types of brain bleeds in babies include:

• Cerebral Hemorrhage: This is classified as a type of hemorrhagic stroke occurring due to a ruptured blood vessel. It results in bleeding inside the baby’s brain, usually leading to devastating neurodevelopmental outcomes.


• Subarachnoid Hemorrhage: This neonatal brain bleed occurs between the arachnoid mater (middle protective membrane covering the brain) and pia mater (innermost protective membrane covering the brain). This is often associated with breathing problems and seizures.


• Intraventricular Hemorrhage: In this case, the bleeding occurs within the brain’s ventricles (where cerebrospinal fluid is produced.) This injury is commonly seen in premature babies, and may lead to developmental delays and problems with movement control.


• Subdural Hemorrhage: In this type of hemorrhage, the bleeding occurs between the dura mater (outermost protective membrane covering the brain) and the arachnoid mater. Subdural hemorrhage can cause respiratory problems, seizures, bradycardia (slow heart rate), and macrocephaly (baby with enlarged head.)

Causes of Intracranial Hemorrhage in Babies

Causes and risk factors of neonatal brain bleeds include:

• Hypoxic-ischemic encephalopathy (HIE), which occurs due to severe oxygen deprivation in the baby’s brain
• Premature baby (blood vessels are underdeveloped and more fragile in premature babies)
• Trauma from prolonged or arrested labor
• Abnormal fetal positioning
• Macrosomia (larger than average size of the fetus)
• Cephalopelvic Disproportion (mismatch between the size of the fetal head and the maternal pelvis)
• Assisted delivery with forceps or vacuum extractors
• Neonatal hypertension (baby’s high blood pressure)
• Blood disorders or clotting (sickle cell disease, hemophilia, and so on)
• Aneurysm (enlarged artery caused by weakness in the arterial wall)
• Brain tumor
• Liver disease

During an assisted delivery, excessive pressure on the baby’s head resulting from improper use of the forceps or vacuum extractor can lead to head trauma and brain bleeds. Poor delivery techniques, such as excessive twisting or overuse of force while pulling the baby’s head may also cause intracranial hemorrhage in the baby.

How Do you Treat Intracranial Hemorrhages in Babies?

The medical provider should be alert to the presence of risk factors for neonatal intracranial hemorrhage. Once the risk is identified, the medical team should perform continuous fetal heart rate monitoring to look for signs of fetal distress.

Preparations should be made ahead of time for an emergency cesarean section to minimize the risk of ICH and other birth injuries. In high risk pregnancies, medical interventions should be used to prevent early preterm birth and ensure safe delivery of the premature baby.

Diagnosing a Neonatal Intracranial Hemorrhage

Symptoms of brain bleeds in babies may appear slowly. Therefore, the medical team should be alert to signs such as feeding difficulties, lethargy, apnea, low APGAR scores, and seizures. If the baby shows one or more of these signs, the medical provider should order the following tests to diagnose ICH and act fast to minimize brain damage:

• Brain MRI scans and CT scans to detect bleeding in the brain or skull
• Cranial ultrasound exam
• Testing of cerebrospinal fluid (CSF) to analyze the underlying cause

Once the baby is admitted to the Neonatal Intensive Care Unit (NICU), a cranial ultrasound should be performed as soon as possible. No radiation is involved in this test. An ultrasound exam along with a detailed neurological assessment may indicate the need for urgent brain surgery.

An MRI test will provide more detailed images of the brain damage to indicate whether hypoxic-ischemic encephalopathy (HIE) has occurred.

Treating Neonatal Brain Bleeds

When a serious ICH (grade 3 or grade 4) is suspected, the baby should be immediately moved to the NICU. Intravenous fluids should be administered and close monitoring should be performed to detect any changes in breathing or heart rate.

If seizure activity is detected, medications should be given to treat the seizures. The baby may also require a blood transfusion. Based on the test results, the affected areas of the brain and the extent of damage should be identified. Tests will also help determine whether the bleeding has spread to the brain tissue. A neurosurgeon will decide if surgery is needed to relieve the pressure from the newborn’s brain.

Most neonatal intracranial hemorrhages are non-progressive, but may result in permanent physical and mental impairments, including cerebral palsy. Long-term physical, occupational, speech, and psychological therapies as well as the use of assistive devices may be necessary to help the child adapt to lifelong disabilities.

Is Your Child’s Birth Injury the Result of Medical Malpractice?

Parents whose children suffer from intracranial hemorrhage related birth trauma or birth complications are entitled to answers as to the cause of their child’s injury and whether mistakes by the doctors and nurses contributed to the injury.

• Were there signs of birth injuries or birth complications during the pregnancy, labor, and delivery process, or presence of risk factors, which were either not recognized or properly treated?
• During the labor and delivery, were there clear indications that their baby was suffering from fetal distress, but appropriate actions were not taken by the obstetrician or nurses?
• Was there a delay in diagnosis of the intracranial hemorrhage that led to later complications, including brain injury?
• Did the medical team fail to order a series of tests to diagnose this birth complication in a timely manner?
• Was the decision to perform a cesarean delivery delayed leading to birth trauma during vaginal delivery or labor?
• Did the neonatal resuscitation team fail to quickly begin important breathing support?
• Should brain cooling (also called “hypothermia therapy”) have been provided to your baby, but the doctors and nurses failed to perform the appropriate tests or ignored the results of the tests?

Our national birth injury attorneys have extensive experience in this and all areas of birth injury medical malpractice. The lawyers and nurses at Miller Weisbrod Olesky will help you determine if mistakes of the medical providers caused a birth injury to your child, including Hypoxic-Ischemic Encephalopathy (HIE) or cerebral palsy.

Our award-winning birth injury attorneys represent families all over the United States in their time of need after a birth injury. We use our experience and expertise to obtain for you and your child a medical malpractice settlement that will help provide specialized medical therapy in order to maximize the quality of life and independence of your child throughout their life.

Sometimes families are reluctant to contact a medical malpractice lawyer. It’s also not uncommon for parents to feel overwhelmed by the responsibilities they encounter in caring for their injured child and worried that they will not be able to help out in a lawsuit involving their child’s birth injury. Our birth injury attorneys and nursing staff will address these hesitations and concerns, so you can focus on your child and maximizing their care.

Registered Nurses and Nurse-Attorneys Are a Vital Part of Our Birth Injury Team…and Yours

Most birth injury law firms will employ one or two nurses to assist the review of cases and medical research. But Miller Weisbrod Olesky offers an unmatched number of nurses and nurse-attorney employees support to both the birth injury attorneys and our clients.

Our team of registered nursing staff and nurse-attorneys bring a deep level of medical and personal insight to every client’s case. Our nursing team includes both an experienced labor and delivery nurse as well as an ICU nurse. Working closely with the rest of the team, they investigate the reasons behind a birth injury and how medical professionals breached their standard of care.

Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?

The only way to find out if you have a birth injury case is to talk to a lawyer experienced in birth injury lawsuits. It’s not uncommon that a birth related complication results in a preventable birth injury, including cerebral palsy, but it takes a detailed expert review by a birth injury attorney of the medical records from your child’s birth to determine if the birth injury was the result of medical malpractice.

At Miller Weisbrod Olesky, a team of committed lawyers, nurses and paralegals uses our detailed medical negligence case review process to assess your child’s potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.

If we feel medical negligence caused or contributed to your child’s injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors. Our birth injury attorneys have recovered millions of dollars in settlements for families of children that have suffered a birth injury.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.

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