Birth Injury Stats in the USA
Birth injury is the traumatic loss or permanent impairment of a baby during or after the birthing process. Although improved medical technology is said to aid in succoring birth injuries, statistics reveal an alarmingly high number of birth injury related deaths in new born.
Here are the stats on this:
General stats
- Birth injuries per year - 28,000; per month - 2,333; per week - 538; per day - 76; per hour - 3
- Out of every 1000 babies that are born in the U.S each year, 7 babies procure birth injuries. Out of these, higher number of injuries occur to male babies than the female ones. It is also revealed that these mostly occur in not-for-profit hospitals.
- More birth injuries occur in large hospitals having over a hundred beds than in smaller ones with less than a hundred beds.
- Six out of the 1,000 possess mild to severe birth injuries like cerebral palsy, erb's palsy, facial paralysis, fractures and spinal cord damages.
- Ten thousand babies who have suffered from birth injury, namely cerebral palsy will develop new cases of this condition.
- Birth injuries are found to cause 20% of all infant deaths.
- Each year one in every 33 babies is affected by birth injuries.
- There are 134 infant deaths per 100, 000 live births caused due to birth injuries.
- According to the Center for Disease and Control, of the study of thirty-eight kinds of birth defects that have occurred between 1979-89, 27 have increased, including, fetal alcohol syndrome, chromosomal defects and cardiac defects. Of these nine have remained the same with only two having decreased.
- 10 per cent of problems seen at birth are linked to environmental factors, drug abuse, biologic or nutrition factors.
- Low weight at birth is the leading cause of infant mortality.
- 6 to 7 per cent birth injuries only surface around the age of one year and 12 to 14 per cent by school age.
Medical negligence
- Improper usage of forceps or vacuum
- Failure to recognize fetal distress
- Recognizing a non- reassuring fetal status
- Improper resuscitation a depressed baby
- Untimely Cesarian section birth
- Instrumental births
Other causes
Smoking: If smoking were stopped during pregnancy- infant mortality decreases by 10 percent and low birth weight (LBW) by 25 percent. Smoking can cause premature death of the baby, respiratory issues and Sudden Infant Death Syndrome (SIDS)
Alcohol: Mothers drinking alcohol cause birth related deaths to their babies including retardation of growth, cerebral palsy and abnormalities to the face. It occurs in 2 out of every 1,000 infants.
Low Birth Weight: Linked to poor maternal nutrition, teenage pregnancy, premature birth, drug and alcohol abuse etc., 12,600 infant deaths can be prevented if mothers received adequate nutrition and pre- natal care.
AIDS: A third of babies born to AIDS infected mother will develop AIDS by 18 months of age.
Prenatal care: 1.3 million women who receive insufficient prenatal care every year cause 25 percent more infant death than normal. Receiving good quality prenatal care can prevent the same.
How does someone get Cerebral Palsy?
Cerebral Palsy is a syndrome or disorder that results in poor posture, movements and muscle coordination. It can be attributed to impairment in the brain, specifically the cerebrum. It affects the connecting links between the cortex and other parts of the brain that control muscle movements and development. There are different variations of CPthat are linked to specific parts of the brain that are poorly affected. In addition to this, the manifestation of each sub-type will also vary.
The first type is Spastic Celebral Palsy that causes rigidity in muscles affecting
movement. Another type is Athetoid cerebral palsy that results involuntary muscular movements. It is also known as Dyskinetic CP. The third type is the Ataxic that causes poor perception and problems with balance. There is also another variation of called the Hypotonic.
The cause of each can be originated to specific parts of the brain.
In general there can be numerous reasons for brain damage that leads to Cerebral Palsy. In some unfortunate cases, one can’t single out any identifiable reason. More commonly, Cerebral Palsy is caused due to intrauterine problems, meaning any imbalances when the baby is still in the uterus. This could range from an injury to the fetus, to inadequate supply of oxygen (called asphyxia) or even exposure to radiation.
Jaundice during pregnancy can also cause Cerebral Palsy in the baby. Any infections during pregnancy can also result in Cerebral Palsy. Some of the infections such as urinary tract infections, rubella and toxoplasmosis that affected pregnant women can actually be prevented, so due care must be taken. Other preventable risks that are strongly correlated with Cerebral Palsy include smoking, having drugs and alcohol consumption during pregnancy. It is clear that drugs and smoking particularly can cause low birth weight or pre-term deliveries which are causes for Cerebral Palsy.
Hence all three should be completed avoided during pregnancy.
There is also some evidence linking Cerebral Palsy to multiple births. At times, only one of the twin might survive but this baby suffers from Cerebral Palsy. This could be due to the shared placenta, resulting in a common blood circulation in some rare cases. Therefore women who seek fertility treatment and get multiple conceptions should be vary of this risk.
Another major risk is having a pre-term delivery. Normally a full-term delivery is after thirty-six weeks of pregnancy so delivering before that can increase the risks of Cerebral Palsy. Mothers with high blood pressure or diabetes are more likely to deliver before the full term. A pre-term birth means inadequate time for the baby to grow in the safety of the womb. In some cases pre-term delivery can be prevented when the tendency is detected while in others it is not preventable or even might be necessary if there is any abnormality in the uterus.
There are quite a few cases of CP after birth also. In general the risk exists until three to five years of age. This can be due to a brain damage or infection in the brain. For instance if there is head injury, an accident or bacterial meningitis. Most of these can be prevented and controlled.
What is Cerebral Palsy?
Every mother wants her baby to be perfect or at least without any problems.
Unfortunately there are some birth defects that can severely affect children. One of the commonest congenital problems is cerebral palsy. As the name suggests it affects the cerebrum, which affects vital connecting parts of the brain. Palsy of course means any problems with movements.
Cerebral palsy is thus a disorder that results in brain impairment. This can be
manifested in varied ways such as poor coordination, inadequate muscle control and problems with movements. The exact kind of manifestation of the problem will actually depend on the specific type of Cerebral Palsy. One can say therefore that the term is an umbrella name for several similar types of conditions associated with motor movements in the body.
As stated earlier there can be different kinds of cerebral palsy. These categories are defined by the specific kinds of impairments in body movements. The origin of each specific type is associated with a problem with a particular part of the brain.
Following are the three broad types:
- Spastic
- Ataxic
- Athetoid/dyskinetic
- Hypotonic
Spastic cerebral palsy is one of the most common types of this disorder and it causes stiffness in the body severely affecting smooth movements. Even within spastic palsy there are sub-types that affect certain areas of the body. For instance in Spastic hemiplegia only side of the body is affected. Another sub-type affects only the limbs of the body, either one, some or all. The names for each of these are Spastic monoplegia, Spastic triplegia and Spastic quadriplegia, respectively. In all of these there could be muscle tightness, some kind of stress or even pain. Closely linked to this is muscle stress related problems such as arthritis or tendinitis that are normally associated with ageing.
In Ataxic cerebral palsy the sense of balance is poor in individuals. They can move around but have difficulty in keeping balance and even have problems with speech along with shakiness. Some people have a severe form of Ataxic cerebral palsy where all these symptoms are of a high magnitude. In some individuals these might be fairly mild and not immediately noticeable also. Fine motor movements such as writing, sewing, using a scissors etc are quite poor in such individuals.
People affected by Athetoid or Dyskinetic cerebral palsy have a combination of muscle tone as the name suggests. So it is both hypertonia or excessive movements and hypotonia meaning slow, sluggish movements. This combination can be impairing for doing daily tasks such as brushing one’s teeth or eating.
In Hypotonic Cerebral Palsy, there is limp, slow movement in the body or at times, none at all. Sometimes physiotherapy can help some individuals but the specific benefits could vary across people.
Individuals with Cerebral Palsy could also suffer from other problems such as poor speech due to poor muscle control. Speech therapy can help individuals deal with this problem. Physiotherapy is also highly useful for people with cerebral palsy for strengthening or relaxing muscles. Another critical problem associated with this disorder is epilepsy, which can cause some complications. Life long medications are recommended to keep the situation in control.
The most important thing to remember about people with Cerebral Palsy is that the conditions are mostly physical. Many of the sufferers have normal or very good intelligence levels.
What is Erb’s Palsy?
Nerve injuries can occur when the baby is passing through the mother’s birth canal and the baby is too big or the mother’s pelvis is too small. In some instances there can be shoulder dystocia which means that the shoulder gets stuck under the pelvic bone while passing through the birth canal. Often a doctor who is trying to deliver a baby may not realize that the baby is stuck and may try to exert force on the baby’s head which would cause stretching or tearing of a group of nerves that run from the neck to the shoulder. So when a baby is born with a limp arm, only time can tell whether it’s a permanent condition.
Erb’s palsy is a partial or total paralysis of the arm and hand, caused by the birth injury of nerves at the root of the arm due to stretching of the brachial plexus. The brachial plexus is formed from the ventral routes C5 to T1 with small additions from C4 and T2. The ventral routes C5 and C6 unite to form the upper trunk which continues to become the major component of the lateral cord. The ventral route of the seventh cervical nerve becomes the middle trunk and together with portions of the lower trunk continues to become the posterior cord. Finally the ventricle routes of the eighth cervical nerve and the first thoracic nerve form the lower trunk which together
with portions of the middle trunk becomes the medial cord. In Erb's palsy, there is damage to the nerves C5, C6 and even C7. The severity of the impact depends on the severity of the injury.
The nerves that extend to the arm arise from the cords. They are the musculocutaneous nerve from the lateral nerve, the medium nerve from the lateral and medial cords, the ulnar nerve from the medial cord and finally the radial and axillary nerves from the posterior cord. The brachial plexus passes through the interscalene groove relatively close to the surface between the Scalenus anterior muscles and the Scalenus medius muscles. In case of Erb’s palsy there could be partial or complete paralysis of these muscles.
The formation of the separate cords occurs just above the clavicle. The main indication of Erb's Palsy is sensory loss in the radial nerve that runs along the dorso side of the upper arm to the epicondyle of the humerus. The axillary artery is contained together with the cords in a common sheath which goes beneath the clavicle in the direction of the axilla. This neurovascular sheath
should run from the deep cervical fascia to the axilla. Instead axillary nerve passes through the lateral axillary groove to the anatomical neck of the humerus and hinders the muscular, nervous and circulatory development of the affected.
On the sensory basis, the nerve supplies motor fibers to the lateral shoulder and the dorsolateral upper arm, which keeps the deltoid muscle active. The musculocutaneous nerve passes between the biceps and the brachialis muscles to the lateral arm. It supplies sensory fibres to the radial side of the forefarm and motor fibers to all flexes of the upper arm. As a result the deltoid, biceps as well as the brachialis muscles could suffer from absolute paralysis or atrophy.
Facts and Stats about Erb’s Palsy in the US
Erb’s palsy is a complication of childbirth, especially sustained in the period of expulsion. It is often a repercussion of shoulder dystocia but can also occur in other ways. During difficult deliveries, Erb’s palsy can occur when the baby is too large, the mother’s pelvis is too small or when the doctor pulls and performs excessive traction on the baby’s head in order to get the baby out in a quick and prompt manner. While getting the baby out safely is of paramount importance, there are a number of things a doctor can do to try and relieve the stuck shoulder from the mother’s pelvic bone without actually putting his hand on the baby’s head. Statistically most injuries that have occurred to a baby’s stuck shoulder have resulted from excessive pulling and traction causing a tearing or stretching of the nerves at the root of the shoulder.
In typical Erb’s palsy, it results in a limp or atrophic arm in which the muscles shrink down in size and can no longer be used for any purpose. It can be devastating for a baby to go through life as he gets older to have an arm that is not functional. Over the course of the child’s early development it should be observed whether the child is making any improvement. Based on that the child’s pediatrician may recommend a pediatric neurologist to examine him and see whether he is progressing or the injury suffered is a long-term and permanent one. A review of the child’s affected nerves is made approximately one month after his birth with additional tests such as electromyography.
It is estimated that 60-70% of children with such birth injuries recover completely within 2-3 months after birth. Studies have shown that children who recover fully, usually get a quick active elbow flexion. However, the longer the child doesn’t make any progress the worse is the prognosis. In such a case there remains a significant chance of partial or complete paralysis of the shoulder and elbow muscles. In some severe cases, neurological reconstruction could be used to avoid permanent impairment of the arm.
The affected arm is usually the anterior limb which is subjected to greater exertion and traction at the time of expulsion. There are also some cases of an impaired posterior limb. The paralysis is mostly always unilateral and the diagnosis is often obvious at birth. The newborn remains motionless with one arm and yet being able to move the other arm. In about 1% of Erb’s palsy
cases, the paralysis is bilateral.
There are two main types of paralysis:
1. Partial paralysis which reaches only up to the shoulder and elbow,
2. Total paralysis (20-30% of cases) of the entire arm from the shoulder up to the hand.
Fractures in the clavicle or humerus, phrenic nerve paralysis and the sign of Horner (closed eye on the paralysis affected side) are signs that are often associated with Erb’s palsy. Earlier it used to be very difficult to predict the level of recovery possible. But spontaneous recovery in the span of 2-3 months is now possible and depends on the severity of the injuries. If spontaneous recovery is not significant after one month, it is likely that the child will retain the injury. Nerve surgery, however, is feasible from the age of three months.
Cerebral Palsy Stats in the US
Cerebral Palsy is one of the most common birth related disorders in the world. This is the condition that is attributed to brain damage before birth, at the time of birth or even the first 3 to 5 years of age. As the name suggests this disorder affects body movements, muscle strength and motor movements. People with Cerebral Palsy (CP) might also suffer from other problems such as poor vision, epilepsy, learning difficulties and speech problems. Unfortunately there is no cure for the disorder, only different specialized therapies that can help patients cope with and work around the
disorder.
Broadly the disorder can be classified into four categories depending on which kind of movement problem exists. The four types are Spastic Cerebral Palsy, Athetoid (or dyskinetic) Cerebral Palsy, Ataxic Cerebral Palsy, and Mixed Type. The most commonly prevalent sub-type is Spastic CP that affects 70 to 80 percent of the people with Cerebral Palsy. It is characterized by stiffness in muscles leading to rigid movements.
Only about 10 to 20 percent of the patients get Dyskinetic/Athetoid cerebral palsy. As the name suggests there are slow, slurry and, at times involuntary movements. The most uncommon type of Cerebral Palsy of course is Ataxic cerebral palsy that is found in only 5 to 10 percent of individuals. It may involve poor coordination and spatial intelligence.
According to United Cerebral Palsy, one of the oldest American organizations working for people with Cerebral Palsy, Cerebral Palsy affects nearly 800,000 people in the US. While Cerebral Palsy is mostly a congenital disorder, affecting babies at birth, close to 10 or 20 percent of babies might also be affected after birth.
The problem can occur up to 3 to 5 years of age. In fact there are cases of Cerebral Palsy as an outcome of medical negligence. There are some preventable causes of Cerebral Palsy also. For instance there is 100 percent likelihood of low birth weight babies to develop Cerebral Palsy. According to the US Center for Disease Control and Prevention, annually there are close to10,000 babies per year in the U.S. who get cerebral palsy.
The causes of Cerebral Palsy can be several such as brain infection or injury to head in the first few years of life. Congenital CP could be attributed to jaundice during pregnancy, poor supply of oxygen to fetus, injury etc.
It must be borne in mind that although Cerebral Palsy is caused due to a brain impairment, it primarily affects physical movements and muscles. Most of the people with Cerebral Palsy will have a fairly good intelligence level. There are unfortunate two-thirds of individuals with Cerebral Palsy who could be mentally impaired.
Today there is no cure for Cerebral Palsy. So the best option for sufferers is a
combination of different therapies that can improve the quality of life and provide skills to individuals with Cerebral Palsy. Naturally there is a cost associated with this, in addition to numerous life long medications. It is estimated by the National Institute of Neurological Disorders and Strokes (NINDS), having a national presence in the United States, that for someone with Cerebral Palsy the lifetime cost of the disorder is as high as $1million. Moreover this cost excludes other costs such as visits to hospitals, residential care needed and put of pocket expenditure.
What is a birth injury?
Child birth is a joyous phenomenon to many. Sometimes, however injuries may be sustained by the baby during the birthing process that may lead to lifelong trauma for the family and child. Usually occurring during a transit through the birth canal, most birth injuries are often due to incompetence
and negligence on the part of doctors and medical staff. The rate of birth injuries are lower than previous decades thanks to better quality prenatal assessment, the advent of ultrasonography and the possibility for perform cesareans.
Due to extreme sensitivity at the birthing stage, injuries can occur on any part of the body of the baby. Those that affect the head and neck prove to be the most dangerous however. Injuries can also occur if the birth canal is too small or if the fetus is too large. Some injuries like Cephalohematoma (blood accumulation below the skull of the bones), injury causing swelling and bruising of the skins soft tissues and common birth marks like milia, Mongolian spots and pink marks require little to no treatment at all. Discussed below are the most common types of birth injuries that occur.
Cerebral Palsy: This affects movement and co-ordination of the muscle and body as a result of brain damage during or after birth.
Erb's palsy: Also called a brachial plexus injury, this causes damages to the brachial area. The brachial area consists of the nerves that control muscles on the shoulders, arms and hands, damage to which can lead to paralysis of the same.
Facial or Bell's Palsy: Causing paralysis to a side of the face, the symptoms of facial palsy are numbness of the face, dry mouth, loss of taste on the tongue, dry or watery eyes, ear pain and dribbling while drinking or after cleaning teeth.
Fractures: This can include skull fracture- causing break in the bones that surround the brain and clavicle (collarbone fracture).
Umbilical Cord Complications: Death or distress to babies are caused when the umbilical cord wraps itself tightly around the baby's neck or getting compressed between the baby and mother's pelvis, thereby cutting off oxygen supply to the baby.
Brain damage: Occurring due to a lack of oxygen supply to the baby, it is most often caused by umbilical cord complications or loss of blood.
Eye infections: This occurs as the baby's body has not yet built up its immunity and is extremely vulnerable to germs.
Neo- natal hypoglycemia: Causing respiratory distress, lethargy and thermo-regulatory problems-this occurs due to an abnormally low level of blood glucose.
Skin irritations: These take the form of red spots or itchy patches. These are common and can be mostly treated easily.
Hip dysplasia: Two in 1000 babies have a hip that is dislocated. Caused by abnormal development of the hip, arthritis is a long term cause of untreated hip injuries.
Scarring: This occurs as a result of improper handling of equipment by obstetricians on the baby.
Most birth injuries are not an uncommon phenomenon with hundreds of babies getting affected every year. Injuries that occur as a result of medical negligence can also be taken to trial in any court of law. It is important to stay calm and get your baby treated right away if he/she shows symptoms or is diagnosed with any of the injuries. Treatment along with a positive attitude adopted by family often leads to recovery and a healthier life for most babies thereafter.