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Why Some Newborns Have Bleeding Around Or Inside The Brain

Little boy kissing a baby

A newborn baby with bleeding around or inside the brain is always a scary thing for parents, but it’s more common than you might have known. The baby’s head must make a difficult journey through the cervix and vaginal canal, which can result in bleeding injuries, especially in premature babies. The severity of such a bleed depends on the location and the amount of bleeding.

Bleeding Outside the Skull

Babies’ heads are fragile, and the process of labor can cause injuries with bruising or swelling in the layers of skin and tissue that surround the outside of the skull. There are two main types of birth injuries that occur here:

  • Caput succedaneum results from body fluid, such as blood, that builds up between the scalp and the periosteum. It can create a nasty looking bump, but it’s usually a minor injury that resolves on its own.
  • Cephalohematoma is when body fluid builds up between the periosteum and the skull. It will also develop a bump on the head, but this can be far more serious than caput succedaneum. According to WebMD, a cephalohematoma generally won’t heal on its own. It could be a dangerous situation in which there is a skull fracture. They tend to develop more slowly than caput succedaneum, so if the baby starts developing swelling of the scalp after the baby is home from the hospital, that’s the sign that the baby needs immediate medical attention.

Bleeding Inside the Skull

Intracranial hemorrhaging refers to bleeding inside the skull. Inside the skull there are several layers of tissue, important spaces between layers, as well as the brain matter and other parts of the brain (see the illustration below). A birth injury can involve bleeding that occurs at or between any of the layers or in multiple layers.

Types of Intracranial Bleeding

The type of intracranial bleeding injury depends on the location of the bleeding (see the illustration above). Some are referred to as a hematoma (the collection or pooling of blood) or a hemorrhage (bleeding from a ruptured blood vessel). They include:

  • Epidural Hematoma: Bleeding between the dura mater and the skull
  • Subdural Hematoma: Bleeding between the arachnoid mater and the dura mater
  • Subarachnoid Hemorrhage: Bleeding in the subarachnoid space
  • Intraventricular Hemorrhage: Bleeding into fluid-filled spaces of the brain called ventricles (not shown in illustration)
  • Intracerebral Hemorrhage: Bleeding inside the gray or white matter of the brain

Grading System

Doctors have a grading system (1 to 4) for intracranial hemorrhages, based on where the bleeding is happening in the brain and how dangerous it is. Grades 1 and 2 generally have a good prognosis. Grade 3 has a mortality (i.e., death) rate around 20%, and Grade 4 has a 90% mortality rate. Intracranial hemorrhages in newborns are usually minor birth injuries where the baby makes a full recovery, but in rare instances, they can be very serious, with the possibility of  brain cell damage, life-long complications, and disabilities, according to Johns Hopkins.

Symptoms of Intracranial Hemorrhaging

Symptoms of intracranial hemorrhaging can include:

  • bulging of the fontanelle (the area where the baby’s skull bones come together)
  • seizures
  • temporary interruptions of breathing (apnea)
  • lethargy (baby doesn’t have much energy or move much)
  • slowed heart rate (bradycardia),
  • abnormal buildup of fluid in the brain (hydrocephalus).

Causes

Some brain bleeding injuries are unavoidable, such as with very premature babies and some birth defects. Others are caused by medical malpractice, such as improper use of forceps or vacuum extractors, a C-section that should have been ordered or was ordered too late, mismanagement of an abnormal baby position (e.g., breech birth), errors related to labor-assisting medications, and other actions or lack of actions that depart from the established standard of care. If you or a loved one believe you might be the victim of negligence leading to a birth injury, get answers and get justice with a free call to: (410) 698-1717 or contact us online.

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