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Did Your Newborn Suffer Cerebral
Palsy or Another Brain Injury Before
or During Labor and Delivery?

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Our Birth Brain Injury Resource Guide

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Get a FREE guide of resources available throughout Ohio to children and families of children who were born with brain injuries.

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In babies that are born with hypoxic ischemic encephalopathy (HIE) – a lack of oxygen and blood flow to the brain – it is important to prevent the chances of prolonged fetal oxygen deprivation and therefore permanent infant brain damage. That is why medical professionals must aim to identify any signs of HIE as early on as possible, and begin the hypothermia treatment within six hours of birth or sooner. The sooner HIE is detected, and appropriate action was taken, the less likely the child is to sustain permanent or severe brain damage.

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Failure to act fast and detect and diagnose HIE may be viewed as medical malpractice that can result in cerebral palsy, infant brain damage, periventricular leukomalacia, and a range of other neurodevelopmental disabilities. Also, failure to perform or offer hypothermia treatment on an infant with HIE is considered medical malpractice.

Challenges During Cooling Therapy

One of the most common challenges during the induction of therapy is the failure to reach the goal temperature timeously. Failure to get the infant’s temperature to the goal temperature or maintain it can also result in shivering. Adequate sedation may be necessary to control shivering, particularly during the therapy.

One particular complication of therapeutic cooling is coagulopathy, or bleeding disorders. However, cooling therapy very rarely leads to spontaneous bleeding.

Coagulopathy in Newborn Babies

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Newborn babies with hypoxic ischemic encephalopathy-are at greater risk for coagulopathy due to the systemic deprivation of oxygen. Furthermore, therapeutic hypothermia slows down enzymatic activity on the coagulation cascade which can result in constitutive prolongation of coagulation.

Signs and Symptoms of Coagulation

The signs and symptoms tend to vary with the cause, the amount of blood lost, and the underlying problem. However, signs of abnormal bleeding often include:

  • Excessive bruising
  • Petechiae
  • Umbilical oozing
  • Bleeding from puncture sites
  • Hematuria
  • Gastrointestinal bleeding
  • Subgaleal hemorrhage
  • Pulmonary hemorrhage

Neonatal Bleeding, Cooling Therapy, and Transfusion Therapy in Infants

Neonatal infants who have severe congenital disorders are more vulnerable for coagulation, or bleeding, particularly intracranial hemorrhage. Neonates with HIE tend to develop decreased platelet survival, thrombocytopenia, decreased platelet function, and are therefore at an increased risk for bleeding.

Coagulopathy is one of the consequences of compromised blood and oxygen supply to the liver and bone marrow in an infant with HIE. The treatment is known to slow enzymatic activity that contributes to the coagulation cascade. Sadly, studies have reported a high rate of coagulopathy in infants, often resulting in the need for transfusion therapy.

Both transfusion therapy and monitoring the bleeding during treatment tend to vary between practitioners. It remains unclear what laboratory abnormalities tend to be predictive of bleeding during cooling therapy, and it is still unclear whether transfusion therapy would successfully target coagulation. However, identifiable coagulation thresholds can guide transfusion therapy in infants at risk of bleeding.