Birth Trauma and the Timing of Injury: Brain Imaging

Written By:Richard Halpern, Senior Counsel

This article will touch on establishing the timing of newborn neurologic injury with the help of imaging of the brain. When a baby is diagnosed with cerebral palsy or other neurological injury, one of the questions you may have is whether the injury could have been prevented.  The answer to this question will depend on when your baby was injured (timing) and how the baby was injured (mechanism). If it can be established that the brain injury occurred during labour and delivery, when mother and fetus were being cared for by doctors and nurses, you may have a claim against the care providers. Newborn neurologic injury can occur any time during pregnancy, during labour and delivery and during the first days and weeks of life.  To succeed in a claim for birth injury, the personal injury lawyer representing the injured child must prove how and when injury occurred and that something could have been done to prevent that injury. Birth injury lawyers representing injured children must prove when injury occurred. How can you tell when the brain is injured? Very important clues about both how and when injury occurred will be found in images taken of the newborn brain in the first days of life.  Usually, multiple images of the newborn brain need to be taken over the first couple of weeks, with early imaging, in the first 2 to 3 days, being very important. There are essentially three imaging techniques that doctors use to see the newborn’s brain. They can use:

• An Ultrasound scan;
• A CT scan, or
• An MRI scan.

These techniques are used by neuroradiologists to provide important information about the condition of the newborn brain and any abnormalities.  Each of these methods provide different information about the newborn brain, with MRI being the most sensitive and revealing tool for accurately identifying potential problems. Importantly, neuroimaging will allow the doctor to determine whether any injury seen on these films occurred close to the time of birth, when they may have been preventable, or more remotely from the time of birth, when they may not have been preventable.  It is possible to use imaging of the newborn brain to define a “window of opportunity” when the injury probably occurred.  Sometimes imaging can tell us that the injury occurred within a week or so of birth, but sometimes it can narrow the window of opportunity significantly – even to 24 hours or so. Imaging will show the affected areas of the brain, the distribution of injury and, therefore, the mechanism or how the brain was injured.  Certain harmful events occurring during labour lead to very specific brain injury patterns.  Where these patterns appear on imaging, it is a strong indicator that the injury occurred during labour. Where an injury occurs at or around the time of birth, one expects the development of cerebral edema, or swelling, between 24 hours and 48 hours of life.  This swelling reaches a peak at about 3 to 5 days of age and then begins to disappear over the next few days, leaving evidence of permanent injury.  The final pattern of injury can be seen by 7 to 10 days of age. This evolution of injury allows experts to comment about the timing of injury. Where the evolution follows this pattern it proves, with a high degree of certainty, that the newborn’s brain injury occurred at or near the time of birth. Once neuroimaging is used to prove the window of opportunity for brain injury, it is necessary to look at other clinical data to refine or narrow the timing of injury.  Refining the timing of injury requires help from multiple medical experts, including obstetricians and neonatologists.  Data about events occurring during labour together with data about the condition of the newborn are crucial to narrowing the window of opportunity and to be more precise about when injury occurred.  Once the timing has been sufficiently refined, we then look to see whether something should have been done to avoid the injury. No question is too small. Contact a Birth Injury Lawyer Birth Injury cases are complex and require a significant amount of skill and experience when representing a client respectfully to secure the compensation they rightly deserve. If you believe that your child may have suffered a brain injury from medical malpractice, it is advisable to contact a birth injury lawyer. Initial consultations are always free of charge or obligation, and the expertise of a medical malpractice lawyer will be invaluable in providing advice as to whether there appears to be grounds to investigate a potential medical malpractice action. Helping our clients understand their rights under the law and being ready to explain the process every step of the way is a part of Gluckstein Lawyers’ commitment to full-circle care. To learn more about how we can help you, contact Richard Halpern at halpern@gluckstein.com, or call 416-408-4252, Ext.263.