Intracranial Hemorrhage

• Birth Complications
• Intracranial Hemorrhage

What is an Intracranial Hemorrhage, or Brain Bleed?

A neonatal intracranial hemorrhage (ICH) or brain bleed is a birth injury that may occur during childbirth, resulting in bleeding inside the baby’s brain. In this birth complication, the tearing of blood vessels within the baby’s brain causes the blood to spread to other parts of the brain tissue.

Intracranial hemorrhage is a leading cause of unfavorable neurological outcomes in infants. Initial symptoms may be subtle, and the medical team assisting with the labor and delivery should be trained to detect, prevent, and minimize brain bleeds.

Babies who have suffered hypoxic-ischemic encephalopathy (HIE) around the time of birth are likely to have intracranial hemorrhages. Both HIE and/or ICH put the baby at an increased risk of cerebral palsy. Long-term complications may include hemiplegia (paralysis in one side of the body), ataxia (loss of muscle control), developmental delays, and cerebral palsy.

Brain bleeds may occur when the obstetrics team makes poor choices during labor and delivery, resulting in brain damage to the baby. When a medical provider fails to properly monitor a high-risk pregnancy where premature delivery was a distinct possibility or fails to recommend a cesarean section when it was the best course of action available especially in the face of fetal distress, the resulting neonatal intracranial hemorrhage may constitute medical malpractice. Examples of medical malpractice that can cause intracranial hemorrhages include:

• Failure to properly monitor a high-risk pregnancy where premature delivery was a distinct possibility
• Failure to recommend a cesarean section when it was the best course of action available, especially in the face of fetal distress
• Negligent use of forceps or vacuum extraction during an assisted vaginal delivery
• Failure to diagnose or treat umbilical cord complications
• Failure to react to fetal distress during labor or delivery
• Incorrect handling of breech baby during delivery

Types of Neonatal Intracranial Hemorrhages

Neonatal ICH can be classified according to the location of the brain bleed. The amount of bleeding and the location where it occurs will determine the extent of brain damage the baby may suffer. Major types of brain bleeds in babies include:

Subgaleal Hemorrhage

Cleveland Clinic - Subgaleal Hemorrhage

When emissary veins between the intracranial venous sinuses and the skull are torn, the blood that collects between the periosteum and aponeurosis of the skull is called a subgaleal hemorrhage. This type of hemorrhage is most common in mechanically assisted vaginal deliveries.

A subgaleal hemorrhage may look like a large, boggy lump on the head that may shift with movement. The baby’s ears may appear swollen, or the head may appear to grow rapidly as the bleeding continues. This type resembles a cephalohematoma, which is contained by the skull’s suture lines while a subgaleal hematoma is not.

If a subgaleal hematoma is unidentified and untreated, there is a high risk of hypovolemic shock, which is when the body’s organs are starved of oxygen and nutrition following a large loss of fluid or blood. Tachycardia (fast heart rate), acidosis, and low blood pressure (hypotension) are also signs of a possible subgaleal hemorrhage.

Subarachnoid Hemorrhage

This neonatal brain bleed occurs between the arachnoid mater (middle protective membrane covering the brain) and pia mater (innermost protective membrane covering the brain). This is often associated with breathing problems and seizures.

In cases of a significant subarachnoid hemorrhage (SAH), hydrocephalus can develop, which is excessive cerebrospinal fluid on the brain. The location of the SAH can also determine the risk of a resulting disability.

Intraventricular Hemorrhage

With an Intraventricular Hemorrhage, the bleeding occurs within the brain’s ventricles (where cerebrospinal fluid is produced). This injury is commonly seen in premature babies and may lead to developmental delays and problems with movement control.

In preterm babies, the area of the brain responsible for creating neurons and glial cells lacks structure, which can cause the blood vessels to rupture. Additional risk factors of IVH include chorioamnionitis (inflammation of the amniotic sac), respiratory distress, and acidosis.

Intraventricular hemorrhages are graded between one and four. Grade III and IV intraventricular hemorrhages are severe and carry a greater risk of developmental delays and mortality. Grades I and II are less severe, but some studies suggest that they may slightly increase the chance of cerebral palsy.

Subdural Hemorrhage

Cleveland Clinic - Subdural Hemorrhage

In a subdural hemorrhage, the bleeding occurs between the dura mater (outermost protective membrane covering the brain) and the arachnoid mater. Subdural hemorrhage can cause respiratory problems, seizures, bradycardia (slow heart rate), and macrocephaly (baby with enlarged head).

Subdural hemorrhages are often small and asymptomatic and are more likely to happen in vaginal deliveries, especially if forceps or vacuum extractors are used.

There is usually no physical indication of a subdural bleed because it is located within the skull. While small bleeds can heal on their own without complications, a severe or slow-bleeding subdural hemorrhage may be hard to detect. Apnea, respiratory distress, and seizures are possible indicators of this type of hemorrhage.

What Causes Intracranial Hemorrhage in Babies?

Causes and risk factors of neonatal brain bleeds include:

• Hypoxic-ischemic encephalopathy (HIE), which occurs due to severe oxygen deprivation in the baby’s brain
• Premature baby (blood vessels are underdeveloped and more fragile in premature babies)
• Trauma from prolonged or arrested labor
• Abnormal fetal positioning
• Macrosomia (larger than average size of the fetus)
• Cephalopelvic Disproportion (mismatch between the size of the fetal head and the maternal pelvis)
• Assisted delivery with forceps or vacuum extractors
• Neonatal hypertension (baby’s high blood pressure)
• Blood disorders or clotting (sickle cell disease, hemophilia, and so on)
• Aneurysm (enlarged artery caused by weakness in the arterial wall)
• Brain tumor
• Liver disease

During an assisted delivery, excessive pressure on the baby’s head resulting from improper use of the forceps or vacuum extractor can lead to head trauma and brain bleeds. Poor delivery techniques, such as excessive twisting or overuse of force while pulling the baby’s head may also cause intracranial hemorrhage in the baby.

Diagnosing a Neonatal Intracranial Hemorrhage

Symptoms of brain bleeds in babies may appear slowly. Therefore, the medical team should be alert to signs such as feeding difficulties, lethargy, apnea, low APGAR scores, and seizures. If the baby shows one or more of these signs, the medical provider should order the following tests to diagnose ICH and act fast to minimize brain damage:

• Brain MRI scans and CT scans to detect bleeding in the brain or skull
• Cranial ultrasound exam
• Testing of cerebrospinal fluid (CSF) to analyze the underlying cause

Once the baby is admitted to the Neonatal Intensive Care Unit (NICU), a cranial ultrasound should be performed as soon as possible. No radiation is involved in this test. An ultrasound exam along with a detailed neurological assessment may indicate the need for urgent brain surgery.

An MRI test will provide more detailed images of the brain damage to indicate whether hypoxic-ischemic encephalopathy (HIE) has occurred.

What Are the Complications of an Intracranial Hemorrhage?

During infancy, the developing brain is in the process of structural and functional maturation. When a trauma like an intracranial hemorrhage affects the neonatal brain, adverse neurological side effects are common.

Depending on the location, extent, and severity of bleeding, an intracranial hemorrhage can negatively impact the trajectory of a child’s life. Complications that may occur from bleeding on the brain include:

Hydrocephalus

Hydrocephalus, or "water on the brain," is a medical condition that occurs when there is an excessive build-up of Cerebrospinal Fluid (CSF) in the brain. Although this fluid is a normal and necessary part of the brain's functioning, if there is a blockage flow, a lack of absorption, or overproduction of this fluid, the brain can be negatively affected.

Excessive cerebrospinal fluid can lead to increased pressure on a baby's brain, expand their skull bones, and cause brain damage of varying severity. Hydrocephalus happens in 1 or 2 of every 1,000 births and most often occurs due to trauma to a baby's head during labor and delivery.

Depending upon the area of the brain affected and the severity of the damage, some children with this condition could end up experiencing developmental disabilities, cognitive and behavioral difficulties, hypoxic-ischemic encephalopathy (HIE), cerebral palsy and/or seizures.

About Hydrocephalus

Cerebral Palsy

Cerebral palsy (CP) is an umbrella term that covers a group of non-progressive, but usually changing, motor loss or impairment. Gross motor functioning is only possible with electrical signals that are sent through the body’s central nervous system. Cerebral palsy disrupts these signals.

Cerebral palsy is caused by a brain injury or abnormal brain development before, during, or immediately after birth. Body movements are affected by the ensuing brain damage, including:

• Muscle tone
• Posture
• Muscle coordination and control
• Reflexes
• Balance
• Fine, gross, and oral motor functions

The impaired muscle movement throughout the body may result in the inability for a child to walk independently, speak clearly, or control facial expressions. The type of cerebral palsy can determine what motor functions are likely to be affected.

About Cerebral Palsy

Cognitive Impairment

The brain damage that results from an intracranial hemorrhage can affect cognitive function. The extent and nature of cognitive impairment depend on several factors, such as where the brain bleed occurred and its severity.

Cognition is the ability to use one’s mental processes to accurately perceive, learn, reason, and understand the world around us. Cognitive functioning also includes the performance of awareness, judgement, intuition, memory, and language capabilities.

These abilities allow us to communicate, build relationships, achieve goals, solve problems, and more. A child’s brain injury may affect both their physical and cognitive functioning.

Cognitive impairment can be difficult to detect, especially in young children. One of the best ways to identify if your child is struggling with cognitive functioning is to observe them closely.

Even infants should respond to external stimuli like sound and touch. If a child is unresponsive to external conditions, or if they fail to meet developmental benchmarks, a consultation with a physician is imperative.

Cognitive impairment can manifest into learning or intellectual disabilities. A learning disability is defined by an atypical processing of information that typically affects how an individual reads, writes, or does math. An intellectual developmental disorder (IDD) is a limitation in mental abilities that affect learning, intelligence, and everyday skills.

About Cognitive Impairment

Vision and Hearing Difficulties

Children with vision impairments are at a major disadvantage for meeting expected developmental milestones. Sense of sight plays an invaluable role in not only visual development, but also in cognitive, social, and motor development.

Brain injuries at birth can damage neural pathways and critical structures required to see clearly. And while these kinds of injuries are usually rare, their probability of happening increases when healthcare providers make preventable mistakes.

Hearing is fundamental to speech development, building relationships, and sensing danger. Having hearing impairments from an early age can delay other important developmental milestones related to speech, language, and communication.

The ear and the brain work together to capture and process external sound waves into meaningful noise. Damage to structures within the ear or the brain can disrupt this process. The three categories of hearing loss include conductive, sensorineural, and mixed hearing loss.

About Vision and Hearing Delays

Fetal or Neonatal Death

It’s many expecting parents’ greatest fear: the death of their newborn child. While losing an infant is unimaginably traumatic, it only becomes more devastating with the knowledge that it could have been prevented.

Infant death (or neonatal death) refers to a child whose passing occurs in the first 28 days of life. In 2024, the CDC estimated that out of 1000 births, approximately 3.6 cases resulted in neonatal mortality.

A child’s death is legally considered “wrongful” if it was preventable, meaning that negligence or medical malpractice caused the fatality. Not all infant death is wrongful; some newborns naturally pass away from unpreventable birth defects or birth complications.

But medical errors can sometimes cause or exacerbate these complications, resulting in a fatal birth injury. Severe intracranial hemorrhages that cause bleeding over large, critical areas of the brain may be fatal if damage is extensive or if treatment is delayed.

About Infant Wrongful Death

How Do you Treat Intracranial Hemorrhages in Babies?

The medical provider should be alert to the presence of risk factors for neonatal intracranial hemorrhage. Once the risk is identified, the medical team should perform continuous fetal heart rate monitoring to look for signs of fetal distress.

Preparations should be made ahead of time for an emergency cesarean section to minimize the risk of ICH and other birth injuries. In high risk pregnancies, medical interventions should be used to prevent early preterm birth and ensure safe delivery of the premature baby.

When a serious ICH (grade 3 or grade 4) is suspected, the baby should be immediately moved to the NICU. Intravenous fluids should be administered and close monitoring should be performed to detect any changes in breathing or heart rate.

If seizure activity is detected, medications should be given to treat the seizures. The baby may also require a blood transfusion. Based on the test results, the affected areas of the brain and the extent of damage should be identified. Tests will also help determine whether the bleeding has spread to the brain tissue. A neurosurgeon will decide if surgery is needed to relieve the pressure from the newborn’s brain.

Most neonatal intracranial hemorrhages are non-progressive, but may result in permanent physical and mental impairments, including cerebral palsy. Long-term physical, occupational, speech, and psychological therapies as well as the use of assistive devices may be necessary to help the child adapt to lifelong disabilities.

What is the Prognosis Following an Intracranial Hemorrhage?

The extent, location, and type of the hemorrhage will determine the risk of neurodevelopmental impairment and mortality. Other factors, like if the baby was at term or preterm, can affect the outcome of an intracranial hemorrhage as well.

Generally, less severe brain bleeds typically have very good outcomes, but medical mistakes can increase the risk of complications. If a hemorrhage causes hypovolemic shock, which is a large loss of fluids or blood that starves organs of oxygen and nutrients, the risk of neurodevelopmental impairment is greater.

Subarachnoid hemorrhage typically has a good prognosis, but the location and extent of the brain bleed can affect the possibility of disability. Anti-seizure medication, blood transfusions, and cardiovascular support may be needed in severe cases.

A subdural and subgaleal hemorrhages typically have good outcomes, although very large bleeds may increase the risk of complications. Grade III-IV intraventricular hemorrhages (IVHs) have up to a 20% mortality rate and a higher risk of disability.

When medical professionals fail to identify a fetal hemorrhage or fail to quickly treat an ICH after birth, the risk of adverse outcomes may be greater. Preventable birth injuries caused by medical negligence constitute malpractice.

Is Your Child’s Birth Injury the Result of Medical Malpractice?

Parents whose children suffer from intracranial hemorrhage related birth trauma or birth complications are entitled to answers as to the cause of their child’s injury and whether mistakes by the doctors and nurses contributed to the injury.

• Were there signs of birth injuries or birth complications during the pregnancy, labor, and delivery process, or presence of risk factors, which were either not recognized or properly treated?
• During the labor and delivery, were there clear indications that their baby was suffering from fetal distress, but appropriate actions were not taken by the obstetrician or nurses?
• Was there a delay in diagnosis of the intracranial hemorrhage that led to later complications, including brain injury?
• Did the medical team fail to order a series of tests to diagnose this birth complication in a timely manner?
• Was the decision to perform a cesarean delivery delayed leading to birth trauma during vaginal delivery or labor?
• Did the neonatal resuscitation team fail to quickly begin important breathing support?
• Should brain cooling (also called “hypothermia therapy”) have been provided to your baby, but the doctors and nurses failed to perform the appropriate tests or ignored the results of the tests?

Our Birth Injury Team

Our national birth injury attorneys have extensive experience in this and all areas of birth injury medical malpractice. The lawyers and nurses at Miller Weisbrod Olesky will help you determine if mistakes of the medical providers caused a birth injury to your child, including Hypoxic-Ischemic Encephalopathy (HIE) or cerebral palsy.

Our award-winning birth injury attorneys represent families all over the United States in their time of need after a birth injury. We use our experience and expertise to obtain for you and your child a medical malpractice settlement that will help provide specialized medical therapy in order to maximize the quality of life and independence of your child throughout their life.

Sometimes families are reluctant to contact a medical malpractice lawyer. It’s also not uncommon for parents to feel overwhelmed by the responsibilities they encounter in caring for their injured child and worried that they will not be able to help out in a lawsuit involving their child’s birth injury. Our birth injury attorneys and nursing staff will address these hesitations and concerns, so you can focus on your child and maximizing their care.

Registered Nurses and Nurse-Attorneys Are a Vital Part of Our Birth Injury Team…and Yours

Most birth injury law firms will employ one or two nurses to assist the review of cases and medical research. But Miller Weisbrod Olesky offers an unmatched number of nurses and nurse-attorney employees support to both the birth injury attorneys and our clients.

Our team of registered nursing staff and nurse-attorneys bring a deep level of medical and personal insight to every client’s case. Our nursing team includes both an experienced labor and delivery nurse as well as an ICU nurse. Working closely with the rest of the team, they investigate the reasons behind a birth injury and how medical professionals breached their standard of care.

Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?

The only way to find out if you have a birth injury case is to talk to a lawyer experienced in birth injury lawsuits. It’s not uncommon that a birth related complication results in a preventable birth injury, including cerebral palsy, but it takes a detailed expert review by a birth injury attorney of the medical records from your child’s birth to determine if the birth injury was the result of medical malpractice.

Our Process

Our team of committed lawyers, nurses and paralegals uses our detailed medical negligence case review process to assess your child’s potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.

If we feel medical negligence caused or contributed to your child’s injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors. Our birth injury attorneys have recovered millions of dollars in settlements for families of children that have suffered a birth injury.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.

We work on a contingency fee basis, meaning you will not pay any legal fees until we win your case. We do not pursue any medical malpractice cases unless we fully believe we can win.

Contact us today to schedule your free consultation by calling our toll-free line at (888) 987-0005. You can also reach us by filling out our online request form.