Newborn Brain Bleeds (ICH): Causes, Symptoms, and Malpractice

Newborn Brain Bleeds (ICH): Causes, Symptoms, and Malpractice

Introduction

The birth of a child is a life-changing event, but for some families, joy is immediately overshadowed by devastating news: their newborn has suffered a newborn brain bleed or “intracranial hemorrhage” (ICH). While some brain bleeds are minor, many are catastrophic injuries that result from trauma or oxygen deprivation during delivery, often pointing directly to preventable medical errors. When a child suffers a severe intracranial hemorrhage birth injury, the resulting brain damage can cause permanent neurological conditions like cerebral palsy, epilepsy, severe developmental delays, or even infant wrongful death. If your child was harmed by a brain bleed caused by medical negligence, pursuing an ICH malpractice lawsuit may be necessary to secure compensation for their lifelong care needs.

What is an Intracranial Hemorrhage (ICH) in a Newborn?

An intracranial hemorrhage is a term used to describe any bleeding within the baby’s skull. This bleeding can occur in the brain tissue itself or in the spaces between the skull and the brain. This condition puts excessive pressure on the delicate infant brain tissue, leading to injury or destruction of cells due to reduced blood flow and oxygen. The outcome’s severity depends on the location, size, and duration of the bleeding, and whether the ICH was caused by birth trauma to the head. There are several distinct types of ICH, each with different risks and causes:

• Subdural Hemorrhage (SDH): SDH can range from mild to severe in presentation. Severe cases, particularly those associated with birth asphyxia or extensive bleeding, carry significant risks of mortality and long-term neurological impairment. SDH is frequently caused by excessive force during delivery or misuse of delivery tools
• Intraventricular Hemorrhage (IVH): Bleeding within the fluid-filled spaces (ventricles) of the brain. Severity varies greatly, but IVH is primarily seen in premature infants and can be worsened by sudden, poorly managed blood pressure changes during labor or resuscitation, leading to significant IVH brain damage. Severe IVH may occur alongside hypoxic-ischemic encephalopathy (HIE) when oxygen deprivation affects both brain tissue and blood vessel integrity.
• Subarachnoid Hemorrhage (SAH): Bleeding in the space surrounding the brain (subarachnoid space). This type is generally milder than SDH but can still cause seizures and requires observation, typically resulting from traumatic delivery or severe, sudden oxygen deprivation.
• Epidural Hemorrhage (EDH): Bleeding between the skull and the outermost protective layer (dura). EDH is less common in newborns but is usually caused by a skull fracture resulting from direct, focused trauma during delivery and often requires immediate surgical intervention.

Symptomatic ICH occurs in approximately 1 in 2,000 spontaneous vaginal births, with higher rates in assisted deliveries using vacuum extraction (1 in 850) or forceps (1 in 650).

Causes and Risk Factors Indicating Medical Negligence

While many minor brain bleeds occur as part of the normal stress of delivery and resolve without treatment, severe hemorrhages requiring intervention are more frequently associated with complications during labor and delivery. When such hemorrhages result from a provider’s failure to meet the standard of care, they may constitute medical negligence. Medical negligence occurs when a healthcare provider fails to meet the accepted standard of care, resulting in injury. The most frequent causes of an ICH that may constitute malpractice fall into several key categories.

Misuse of Delivery Tools

The first category involves the misuse of delivery tools. Tools like Forceps and Vacuum Extractors are designed to assist delivery but carry inherent risks. Negligence involves actions such as:

• Applying excessive force with forceps or vacuum extractors, which can lead to forceps injury brain damage.
• Using the tools improperly for too long or in a non-indicated situation, forming the basis for a vacuum extractor injury lawsuit.
• Improper placement, which can directly cause a skull fracture or tear vital blood vessels, leading directly to a Subdural or Epidural Hemorrhage. 

Failure to Timely Deliver

The second category is the failure to timely deliver the child. This often involves a delayed C-section. When a baby shows persistent signs of fetal distress (such as a dropping heart rate or late decelerations) or if labor fails to progress (a condition known as failure to progress), negligence can involve:

• Failure to order an emergency Cesarean section despite clear signs of fetal distress, leading to a delayed C-section brain bleed.
• Ignoring signs that labor is failing to progress.
• Delayed intervention, which results in the baby suffering from oxygen deprivation (hypoxia). Hypoxia compromises the integrity of the brain’s delicate blood vessels, making them prone to rupture and hemorrhage.

Physical Trauma and Excessive Traction

Third, physical trauma and excessive Traction during delivery are major causes. This is frequently seen in cases of shoulder dystocia management, where excessive pulling, twisting, or rotating of the baby’s head and neck can cause extreme forces on the head. This trauma can potentially lead to severe intracranial bleeding and spinal cord injury.

Poor Management of High-Risk Situations

Finally, poor management of high-risk situations can lead to ICH. For example, failing to properly monitor and treat maternal high-risk conditions like preeclampsia/eclampsia can lead to placental abruption or severe fluctuations in the mother’s blood pressure, which in turn affect the fetus. Similarly, in premature infant management, errors in resuscitation, ventilation, or IV fluid management can cause sudden, dramatic shifts in blood flow to the brain, triggering a devastating Intraventricular Hemorrhage.

Recognizing the Signs and Symptoms of a Brain Bleed

A prompt and accurate diagnosis is critical, as emergency intervention can sometimes limit the extent of the brain damage. While severe brain bleeds are often evident immediately after birth, some subtle symptoms may be missed or initially misdiagnosed. Parents and caregivers should know the common symptoms of brain bleed after birth to ensure rapid diagnosis:

• Neurological Distress: Seizures or uncontrollable jerking motions, periods of apnea (stopped breathing), unusual eye movements, or a bulging or tense soft spot (fontanelle) on the head.
• Physical Manifestations: Extreme lethargy or unresponsiveness, changes in skin color (paleness, mottling, or cyanosis), bradycardia (abnormally slow heart rate), or a drastic drop in hematocrit (blood count).
• Motor & Reflex Impairment: Unusual posturing (like a rigid body or arched back), a weak or absent Moro reflex (startle reflex), or a general lack of muscle tone (hypotonia).
• Feeding & Behavior: Difficulty feeding (poor suck/swallow reflex), high-pitched, continuous crying that cannot be calmed, difficulty waking, or unusual sleepiness.

If a brain bleed is suspected, a newborn should immediately undergo imaging, such as a cranial ultrasound, CT scan, or MRI, to confirm the location and severity of the hemorrhage. Failure by the medical team to promptly order appropriate diagnostic tests when clinical symptoms suggest ICH may constitute a breach of the standard of care and could delay critical treatment

Proving Medical Malpractice and Securing Compensation

A diagnosis of Intracranial Hemorrhage is often just the first step. To pursue a successful medical malpractice claim for a birth injury like a brain bleed, your legal team must prove that the injury would not have occurred but for the negligence of the medical providers. Learning how to prove medical negligence in birth injury cases involves establishing four essential legal elements:

1. Duty of Care: The medical provider had a legal responsibility to provide competent care consistent with the medical standard.
2. Breach of Duty: The provider’s actions or inactions fell below the acceptable standard of care.
3. Causation: The provider’s specific breach of duty directly caused the Intracranial Hemorrhage and the resulting permanent brain damage.
4. Damages: The injury resulted in quantifiable harm (medical bills, debility, disability, pain and suffering, etc.).

Calculating Lifetime Damages

The primary goal of a successful birth injury lawsuit is to secure the financial future of the injured child. Compensation is sought to cover the enormous costs associated with a catastrophic, lifelong injury. These items for which compensation may be sought include:

• Future Medical Expenses: Covering lifetime medications, surgeries, and hospital visits.
• Rehabilitative Care: Ongoing physical, occupational, and speech therapy.
• Attendant Care: The cost of 24-hour skilled nursing or home health aides.
• Special Education and Housing: Costs for specialized schooling and necessary home/vehicle modifications.
• Loss of Earning Capacity: Compensation for the income the child will be unable to earn over their lifetime.
• Pain and Suffering: Non-economic damages for the physical and emotional distress endured by the child and the family.

Because of the complexity of these medical records and the need to project costs decades into the future, an experienced birth injury attorney will consult with specialized medical experts (like an obstetrician, neonatologist, and neurosurgeon) and financial experts (like life care planners and economists) to conclusively establish the full value of the claim.

Your Legal Rights and Next Steps

If your child has been diagnosed with an Intracranial Hemorrhage that you believe was caused by medical negligence, time is a critical factor. The statute of limitations (the legal deadline for filing a claim) is strict and complex in birth injury cases. Do not wait to get answers. Consulting with a qualified birth injury lawyer for cases involving brain trauma, or even related brain injuries like Kernicterus, can help you understand your legal rights and hold negligent medical providers accountable for the care and resources your child will need to live the fullest possible life.

The Powless Law Firm is an Indiana law firm that represents victims and families statewide in serious cases involving birth injury, medical negligence, personal injury, nursing home neglect, and wrongful death. If you have concerns about nursing home negligence, please contact us at (877) 469-2864. Together, we can make a difference.

The Powless Law Firm represents families across Indiana—from Indianapolis to Fort Wayne and Evansville—in cases involving birth trauma lawsuits, medical malpractice birth injury claims, and cerebral palsy lawsuits. As experienced medical malpractice attorneys in Indiana, we are here to listen to your story and help you find the way forward.

Call (877) 469-2864 now for a free, confidential consultation. There is no fee unless we win your case.