Causes of Birth Injuries & Cerebral Palsy (CP)

In most cases, the initial cause will never be known. There are known risk factors that can indicate the likelihood for CP, but they do not point to specific causes.

Most conditions are caused by a brain injury that occurred during pregnancy or birth (congenital), or in the months/years following birth (Acquired CP). Cerebral Palsy disorders are caused by faulty development of or damage to motor areas in the brain that disrupt the brain's ability to control movement and posture. A variety of conditions can lead to brain injury, including:

• Genetic conditions and problems with the blood supply to the brain can affect how the child's brain develops during the first 6 months of pregnancy.
• Oxygen shortage - if the oxygen supply to the brain is severely low at the time of birth, the infant may suffer a type of brain damage called hypoxic-ischemic encephalopathy. 
• Rh incompatibility - a blood condition that causes the mother's immune cells to attack the fetus, resulting in jaundice. 
• Severe Jaundice in the child during the first weeks following birth. 
• Toxicity - drug or alcohol use during pregnancy can result in brain damage. 
• Kidney and urinary tract infections - these infections, if severe and prolonged, in the mother can lead to brain damage within the fetus.
• Exposure of the expectant mother to certain infections including rubella, toxoplasmosis and cytomegalovirus. 
• Severe physical trauma to the mother during pregnancy.

Acquired cerebral palsy results from brain damage in the first few months to years of life and can be caused by conditions such as:

• Brain infections - encephalitis, meningitis
• Head injury - falls, automobile accidents, child abuse

Ten to fifteen percent of cerebral palsy cases are caused by a recognized brain injury, such as infection (e.g., meningitis), bleeding into the brain, and damage caused by lack of oxygen. Most causes are unidentified, and medical professionals can simply review present risk factors. Some of the errors made by healthcare professionals during delivery can include:

• The failure to recognize and treat seizures following delivery;
• Failure to order a C-Section in a timely manner;
• Excessive use of a vacuum extractor;
• Failure to detect a prolapsed umbilical cord reducing oxygen supply; 
• Improper use of delivery forceps; 
• Hospital staff may not properly read or respond to the babies vital signs; 
• Failure to declare fetal distress; 
• Failure to diagnose and treat jaundice or meningitis; The following incidents may justify further investigation, or indicate the possibility of a medical malpractice claim:
• The use of resuscitation (CPR) after birth; 
• Emergency delivery with forceps, or by c-section; 
• Special testing after birth, such as an MRI scan, CT scan or brain scan;
• A specialist may not have been consulted when necessary;

Cerebral Palsy Causes

About 70 percent of cerebral palsy cases result from events occurring before birth that can disrupt normal development of the brain. Contrary to common belief, lack of oxygen reaching the fetus during labor and delivery contributes to only a small minority of cases of cerebral palsy, according to a 2003 report by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). A small number of babies also develop brain injuries in the first months or years of life that can result in cerebral palsy. In many cases, the cause of cerebral palsy in a child is not known.

Some of the known causes of cerebral palsy include:

Infections during pregnancy - Certain infections in the mother, including rubella (German measles), cytomegalovirus (a usually mild viral infection) and toxoplasmosis (a usually mild parasitic infection) can cause brain damage and result in cerebral palsy. Recent studies suggest that maternal infections involving the placental membranes (chorioamnionitis) may contribute to cerebral palsy in full-term as well as preterm babies (those born before 37 completed weeks of pregnancy). A 2003 study at the University of California at San Francisco found that full-term babies were four times more likely to develop cerebral palsy if they were exposed to chorioamnionitis in the womb. Reproductive/urinary tract infections also may increase the risk of preterm delivery, another risk factor for cerebral palsy.

Insufficient oxygen reaching the fetus - For example, when the placenta is not functioning properly or it tears away from the wall of the uterus before delivery, the fetus may not receive sufficient oxygen.

Prematurity - Premature babies who weigh less than 3 1/3 pounds are up to 30 times more likely to develop cerebral palsy than full-term babies. Many of these tiny babies suffer from bleeding in the brain, which can damage delicate brain tissue, or develop periventricular leukomalacia, destruction of nerves around the fluid-filled cavities (ventricles) in the brain.

Asphyxia during labor and delivery - Until recently, it was widely believed that asphyxia (lack of oxygen) during a difficult delivery was the cause of most cases of cerebral palsy. The ACOG/AAP report shows that fewer than 10 percent of the type of brain injuries that can result in cerebral palsy are caused by asphyxia.

Blood Diseases - Rh disease, an incompatibility between the blood of the mother and her fetus, can cause severe jaundice and brain damage, resulting in cerebral palsy. Rh disease usually can be prevented by giving an Rh-negative woman an injection of a blood product called Rh immune globulin around the 28th week of pregnancy and again after the birth of an Rh-positive baby. Blood clotting disorders (thrombophilias) in either mother or baby also may increase the risk.

Severe jaundice - Jaundice, yellowing of the skin and the whites of the eyes caused by the build-up of a pigment called bilirubin in the blood, occasionally becomes severe. Without treatment, severe jaundice can pose a risk of permanent brain damage resulting in athetoid cerebral palsy.

Other birth defects - Babies with brain malformations, numerous genetic diseases and other physical birth defects are at increased risk of cerebral palsy.

Acquired cerebral palsy - About 10 percent of children with cerebral palsy acquire it after birth due to brain injuries that occur during the first two years of life. The most common causes of such injuries are brain infections (such as meningitis) and head injuries.

While most doctors, nurses, midwives, and hospital technicians provide a high standard of care for their patients, unfortunately, many families are harmed by medical mistakes. Parents of a child suffering with cerebral palsy should contact an experienced cerebral palsy lawyer to research the cause of their child’s condition. Medical mistakes are responsible for many birth injury cases and it would be impossible for a parent, alone, to determine if medical malpractice caused their child's injury. It is only through the dedicated and thorough efforts of a legal and medical team that the cause can be ascertained.

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