Pediatric Brain Injuries - Degrees of Brain Injury

Parents need to know why their infant suffered an injury and learn more about the extent of the injury. Brain injuries at birth can occur from oxygen deprivation during labor or delivery. It is important to understand the degree of the injury to know what treatments will need to be done and what the short and long-term prognoses will be.

Infants who have suffered a brain injury should be evaluated immediately. Every baby is evaluated at one minute after birth using the APGAR scale. This is a general observational exam of the infant to determine overall health at birth. The categories reviewed include appearance, pulse, grimace, activity, and respiration. A newborn may score between 0 and 10 with ten being perfect. The test is again done at five minutes after birth. If an infant is rating low, the test will be done again after ten minutes.

Infants who score low on the APGAR scale are possibly suffering from some distress or injury. The infant may require resuscitation or could have a weak pulse. These infants should be evaluated for possible neurological injuries.

Categories of Brain Injuries

When an infant suffers a birth injury, the doctor will need to perform various tests to determine the severity of it. Neurological testing is one of the most useful ways for a doctor to make an immediate diagnosis. The neurological test looks at various factors including:

These tests can be easily completed in just a few minutes of monitoring and checking on the infant.

Sarnat Scale

Hypoxic Ischemic Encephalopathy (HIE) is measured using the Sarnat Scale. This is a method of measuring the severity of neurological damage in infants. The doctor examines the child based on the various factors listed above. There are three classifications of HIE brain injuries in the Sarnat Scale.

Stage 1

Stage 1 may be considered mild. The infant is hyper alert and has normal muscle tone. The complex reflexes, such as sucking, are present but weak. Stage 1 infants are not experiencing any seizures.

Stage 2

Infants categorized as Stage 2 on the Sarnat Scale typically have a moderate brain injury. They are lethargic, and their complex reflexes may be absent. They may present with a stiff posture. These infants may suffer from seizures.

Stage 3

Stage 3 is often associated with severe brain injury. The infant is stuporous, and his muscles are flaccid. There are no complex reflexes, and the autonomic function is depressed. Generally, these infants could be in and out of consciousness and may not suffer seizures.

Additional Testing

Additional tests are necessary to determine the severity of the injury. Diagnostic testing may include an MRI, blood tests, ultrasound and an electroencephalogram (EEG). The EEG is a very useful diagnostic tool. The test is performed by placing electrodes on the infant’s head. The electrodes measure the brain’s activity. The results are recorded so they can be fully reviewed. It is helpful for monitoring seizures as well. Infants with mild, moderate or severe brain injuries require additional medical care and treatment. If the infant suffered a loss of oxygen the baby should be treated with cooling therapy within the first 6 hours after birth. This therapy lowers the body’s temperature and may help reduce the secondary effects of brain damage.