Birth Injury Solicitor

The five most common types of birth injuries that our solicitors handle are:

• Erbs Palsy
• Hip Dysplasia
• Hyperbilirubinanaemia and Kernicterus
• Hypoglycaemia
• Cerebral Palsy

Erbs Palsy
The condition known as Erbs Palsy affects less than 1% of newborn infants and is caused by injury to the brachial plexus system of nerves, which may be as a result of clinical negligence for allowing the child's head to be subjected to excessive trauma during birth and delivery. There are well-established, recognised risk factors associated with both the unborn child and the mother, which should be known to any doctor or midwife, including:

• Unusually large child
• Maternal diabetes
• Failure to manage shoulder Dystocia
• Excessive force used to facilitate delivery

Any inappropriate traction applied during delivery can result in strain of the brachial plexus nerves. Claims for compensation usually fall into two main categories:

• Failure to arrange a caesarean section in cases where shoulder Dystocia should have been anticipated
• Negligent handling of shoulder Dystocia as a result of failure to follow established procedures

Shoulder Dystocia is a serious problem which can often result in serious injury or death to the infant. Shoulder Dystocia occurs when the baby's shoulder becomes lodged behind the mother's pelvis. As a result of this the delivery becomes delayed and it is important that prompt and appropriate action is taken. If the shoulder Dystocia is not remedied quickly then asphyxiation or death may occur. There are well known methods of dealing with this emergency which should be familiar to doctors and midwives. These protocols, if applied appropriately, should relieve the problem and include:

• Manoeuvring and changing the baby's position
• Repositioning the mother
• Applying pressure to the pubic area
• Carrying out the McRobert's manoeuvre
• Breaking the mother's pelvic bone
• Emergency caesarean section
• Deep episiotomy cut
• Breaking the baby's clavicle bone on purpose
• Applying traction in a horizontal plane

The brachial plexus nerves emerge from the spinal cord and travel across the shoulder, along the arms to the tips of the fingers, and damage can manifest itself in a number of different ways ranging from the mild to severe and from temporary to permanent. The injury is usually classified according to the area of damage and subsequent effects as follows:

• Klumpke's Palsy - usually includes a limp hand and immobile fingers often associated with Horner's Syndrome (damage to the nerves of the eyelid, or 'droopy eye')
• Complete Brachial Plexus - occurs when the entire arm is paralysed. There may also be Horner's Syndrome and Torticollis caused as a result of nerve damage
• Erb's Palsy - is characterised by the arm being turned towards the body with a stiff elbow and the hand in a 'waiter's tip' position

Surgery is sometimes possible to relieve the problems, as well as extensive physiotherapy, but sadly the problems are sometimes permanent.

Hip Dysplasia
This is a dislocation of the leg from the pelvis. Delay in making a diagnosis of this condition and thus providing appropriate treatment as soon as possible can result in a serious and permanent disability. The condition is not always present at birth and a child may go on to develop the problem at a later stage. Doctors, midwives, health visitors and nurses should take every opportunity throughout infancy to monitor the child and a careful examination of the hips should be carried out at regular intervals until the child is walking normally. If necessary, the child should be referred for ultrasound or x-ray and a subsequent orthopaedic consultation.

What is Hip Dysplasia?
The hip is a 'ball and socket' joint. The top of the thigh bone (femur) is shaped like a ball and fits into a matching cup (acetabulum) on the outer side of the pelvis. Various problems can affect the baby's hip as it develops. Sometimes the ball does not lie safely in the socket and is displaced from it: this is what is meant by dislocation. Sometimes, although the ball is in the socket it can slip in and out of place: this is what is meant by the hip being likely to dislocate. Sometimes, although the hip is in the socket, it is not deeply in place and this is called 'subluxation'. In some children, although the hip is in the right place, the socket does not grow properly and it is too shallow. If the hip pocket is shallow this may allow the ball to move from the position it should occupy.

Of every 1000 babies born, one or two may have a hip that is dislocated at birth. In general, girls are more likely to be affected than boys. The left hip is more often affected than the right.

Most children who have slight instability at birth will get better on their own without the need for specific treatment. It is important to identify these children to be sure that the expected improvement occurs. Babies undergo routine examination of their hips at different stages. At birth they are checked by two tests, called the Ortolani and Barlow tests. The baby is laid on his or her back and the hips are gently taken sideways. It is usually possible for the baby's hip to be taken fully out sideways. If the baby's hip does not move as fully as this, it may be that the hip is not developing properly and further checks and investigations are necessary: an ultrasound in the case of a young baby, but in an older child x-rays are more commonly helpful in establishing the diagnosis.

Babies' hips are subsequently checked when they are six or eight weeks old and when they are six to eight months old. These later checks are usually carried out by a General Practitioner or health visitor. If the Hip Dysplasia is recognised early it can be nearly always treated simply by a splint which may need to be worn for six to twelve weeks. This keeps the baby's hip flexed and out sideways. This is a position in which the hip is most likely to develop satisfactorily.

Sometimes, however, these simple splints do not work and a baby's hip does not become stable and grow normally. Some children's problems are not detected at birth or when they are in infancy and it does not become apparent until they begin to walk. For older children treatment is usually more difficult and sometimes surgery is necessary, but that does not always work and the child can be left with a permanent and severe disability. The earlier the diagnosis, in general, the better the outcome, and the less likely it is that surgery will be required.

What can cause Hip Dysplasia?
In many instances the cause of Hip Dysplasia is unknown. Risk factors can include:

• Breech presentation
• Family history of hip problems
• Lack of fluid surrounding the baby in the womb

Hypoglycaemia in the newborn baby
Hypoglycaemia means 'low blood sugar'. If a baby is born or becomes hypoglycaemic and the condition is not diagnosed or is left untreated, there is a risk of health problems, some of which can be serious.

Every single cell in the body needs a supply of sugar - glucose - to work effectively. The healthy newborn baby has a reserve of glucose which is replenished when feeding. The amount of glucose in the blood is measurable, and if it falls below a healthy level and remains there, the baby could become tired, floppy and may have convulsions. If the level remains low for a long time, then it is possible that brain damage could result.

Which babies are at risk?
The vast majority of healthy, term babies are not at risk of hypoglycaemia. They can cope with normal dips in blood sugar level very easily. Regular and sufficient feeding is very important. However, some babies are at risk. These include:

• Pre-term and small-for-gestational-age babies may have poor stores of glycogen in the liver (needed to make glucose), and be short of body fat (meaning they can't draw on fats for energy). In addition, they may be sleepy and hard to feed
• Babies of mothers who are diabetic
• Babies who have had breathing difficulties at birth
• Babies who have suffered hypothermia (excessive coldness)

Babies at risk of low blood sugar normally have blood tests to check their blood sugar levels are within normal limits. The usual way of testing is to take a pinprick of blood from the foot and to test it with either a reagent strip, which changes colour according to the sugar detected, or with a ward-based or laboratory-based device which checks for sugar electronically.

If your baby is in a high-risk category then he/she should be monitored carefully and the blood sugar levels checked on a regular basis. A failure to do this can have serious consequences. Whilst most babies can recover with appropriate treatment, those who do not receive the necessary and prompt treatment can sustain brain damage.

Hyperbilirubinanaemia and Kernicterus
These are relatively rare conditions of inadequately treated jaundice; however, the consequences can lead to Cerebral Palsy. Jaundice is very common in newborn babies and usually goes away by itself. A little jaundice is not a problem, but a few babies have too much jaundice.

What is Hyberbilirubinanaemia?
This is a condition that develops due to the inadequate treatment of jaundice. If it remains untreated then it will develop into the more serious condition of Kernicterus.

What is Kernicterus?
Kernicterus is a type of brain damage that causes Athetoid Cerebral Palsy and hearing loss. It also leads to problems with vision and teeth and sometimes can cause neurological impairment. In some newborn babies the liver makes too much yellow pigment called bilirubin. When too much bilirubin builds up in a new baby's body, the skin and whites of the eyes turn yellow. This yellow colouring is called jaundice. If not treated, high levels of bilirubin can damage the brain.

Who can develop Kernicterus?
Any baby with untreated jaundice is at risk of Kernicterus. This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice will get better by themselves. If their skin is very yellow, they might need phototherapy treatment. If phototherapy does not lower the baby's bilirubin levels, the baby may need an exchange transfusion of blood. Some babies are more likely to have jaundice than others:

• A sibling who has had jaundice increases the risk
• A baby who has bruises at birth is likely to have jaundice due to the body processing the haemoglobin in the red blood cells, resulting in high levels of bilirubin
• Babies born before 37 weeks may have an underdeveloped liver and be unable to eliminate bilirubin
• Babies who are poor eaters are at risk of jaundice
• A baby who is jaundiced in the first 24 hours of life may become dangerously jaundiced
• Hereditary factors including the children of Mediterranean or East Asian families

What are some of the warning signs of Kernicterus?

• Very yellow or orange skin tones (beginning at the head and spreading to the toes)
• Increased sleepiness, so much so that it is hard to wake the baby
• The baby is not as alert and awake
• High-pitched cry
• Weakness, limpness or floppiness
• The baby's body is arched like a bow (the head and heels are bent backward and the body forward)

Can jaundice be treated and prevent Kernicterus from developing?
No baby should develop brain damage from untreated jaundice. If the baby is in a high-risk group it should be adequately and correctly monitored. If a baby has prolonged jaundice then it too should be carefully monitored. If the bilirubin levels do not decrease, phototherapy is the first stage of treatment; that is to say the baby can be put under blue lights for most of the day. The blue lights do not bother the baby; they are warm and probably feel good. If the baby gets very jaundiced an exchange transfusion takes place.

Call 0800 0 382 382 now for a consultation with a Clinical Negligence Pannone Solicitor or Lawyer.