How brain injury occurs with shoulder dystocia, and the effects

When the oxygen supply to a baby’s brain is compromised, a condition known as hypoxic ischaemic encephalopathy (HIE) may be caused. Like shoulder dystocia itself, HIE is dangerous, so should be treated promptly. There are various ways of ascertaining whether oxygen starvation has occurred, including measurement of cord blood gases; the more acidic the blood samples are, the more likely it is that there has been oxygen starvation.

Babies who have suffered HIE will suffer fitting in the first few days of life (fitting is one of the diagnostic criteria for HIE), the correct response to which is to do a brain scan. This would normally not be performed immediately, but probably after some days, because it takes time for a brain injury to manifest itself on imaging. The diagnostic tools would usually either be ultrasound scan or an MRI (magnetic resonance imaging) scan. Unfortunately, a normal scan doesn’t rule out the presence of a brain injury – it can be that the damage is too subtle for the equipment to detect.

The effects of a brain injury

The effects of HIE vary enormously, depending upon the length and degree of oxygen starvation that occurred.

At the extreme end of the spectrum, where there is a lengthy gap between the onset of oxygen starvation and delivery, a very serious brain injury might well occur. The effects of such an injury can be profound, and will include cerebral palsy – a patient group in which pronounced problems with movement is common.

A moderate or mild brain injury may also occur. In patients who have suffered a relatively mild brain injury, the signs are often subtle, and may not be picked up until some way into the child’s life.

Babies who suffer mild or moderate levels of oxygen starvation will not necessarily develop a permanent brain injury. Others will be left with permanent problems with movement. Still others may manifest quite subtle cognitive impairments. Problems with reading, writing, mathematics and pronunciation can all be suggestive of an underlying injury. Problems with fine motor skills including – perhaps – difficulty with holding a pen or typing could be suggestive, and dyspraxia (issues with coordination) might also be present. Behavioural problems can also occur. Such problems will not just be temper tantrums. Extreme outbursts, meltdowns, difficulties in communicating effectively with other people or grasping other people’s points of view, and obsessive behaviours are all known to be associated with brain injuries. A cluster of these characteristics would be worrying.

It is not unusual for children with mild brain injuries to experience additional difficulties at around the time they enter secondary education. This is partly because educational demands on the child will tend to increase at this time, and partly because children at this age are expected to manifest a greater degree of independence than formerly.

If a subtle brain injury is suspected, that possibility should always be raised with healthcare professionals. A prompt diagnosis can facilitate both educational and pastoral assistance. It is therefore vital that you communicate any concerns you have to your child’s treating clinicians, who will be able to assist. Equally, if you are in the process of bringing a claim arising from Erb’s palsy, it is very important that you discuss the possibility of a brain injury with your legal team. This will enable your lawyers to investigate things for you, and hence ensure the best outcome for your child.

If you would like to discuss any issues raised by this article further with a member of our specialist clinical negligence team, then please do get in touch. We will be happy to advise you.

Alternatively, we are holding two of our popular Erb's Palsy Clinics during next week's Erb's Palsy Awareness Weeks - the week commencing 22 October 2018. Find out more and book your place here.