Brain Injuries Related to Birth

Every parent hopes for a safe delivery and a healthy baby. When a newborn experiences a brain injury around the time of birth, families face one of the most difficult journeys in medicine. These injuries can affect a child’s movement, thinking, and overall development, sometimes for a lifetime.

Understanding what brain injuries are, how they happen, and what treatment options exist can help families make sense of a confusing and emotional situation. This page explains the medical facts about birth-related brain injuries, drawing on current clinical guidelines and research from leading medical organizations and New York’s perinatal care system.

At nybirthinjury.com, we provide trusted information to help families understand birth injuries, navigate medical care, and find the support they need during difficult times.

What Are Birth-Related Brain Injuries And How Do They Happen?

A birth-related brain injury is damage to a baby’s brain that occurs shortly before, during, or soon after delivery. Medical professionals sometimes call these perinatal or neonatal brain injuries. They represent one of the most serious complications that can happen around birth, and they are a leading cause of childhood neurological disability.

These injuries can result from several different problems:

• Lack of oxygen or blood flow to the brain (called hypoxic-ischemic injury)
• Bleeding inside or around the brain
• Blood clots blocking arteries or veins in the brain (stroke)
• Infections that affect the brain before or after birth
• Severe low blood sugar or other metabolic problems
• Physical trauma during a difficult delivery

The severity of brain injury varies widely. Some infants recover with minimal long-term effects, while others face ongoing challenges with movement, learning, vision, hearing, or seizures. Early recognition and treatment can make a meaningful difference in outcomes.

What Types Of Brain Injuries Can Occur During Birth?

Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy, or HIE, is the most common type of birth-related brain injury. It happens when a baby’s brain doesn’t receive enough oxygen and blood flow around the time of delivery. Studies show that HIE accounts for roughly half of all identified cases of brain injury in full-term newborns.

HIE triggers a cascade of damage in brain cells. The initial lack of oxygen causes what doctors call “primary energy failure,” where cells can’t produce the energy they need to survive. After a brief period of partial recovery, a second wave of injury occurs between 6 and 48 hours after birth. During this “secondary energy failure” phase, brain cells die from inflammation, toxic chemical releases, and oxidative stress.

This two-phase pattern creates a critical window of opportunity for treatment. Therapeutic hypothermia, or cooling treatment, works by slowing down the harmful processes that unfold during that second phase of injury.

Babies with HIE may show signs ranging from mild irritability and poor feeding to seizures, extreme sleepiness or unresponsiveness, abnormal muscle tone (either too stiff or too floppy), and difficulty breathing. Doctors use a system called the Sarnat scale to classify HIE as mild, moderate, or severe based on the baby’s symptoms and neurological exam.

Intracranial Hemorrhage And Birth Trauma

Birth trauma refers to physical injuries that happen during delivery. While the term includes minor problems like scalp swelling, it also encompasses serious complications like bleeding inside the skull (intracranial hemorrhage), nerve injuries affecting the arms (brachial plexus injury), and bone fractures.

Significant bleeding in the brain can occur in both premature and full-term babies, particularly after complicated deliveries. Types of intracranial hemorrhage include subdural bleeding (between the brain and its outer covering) and intraventricular hemorrhage (bleeding into the fluid-filled spaces inside the brain).

These hemorrhages raise pressure inside the skull, disrupt normal blood flow, and damage brain tissue directly. The location and extent of bleeding determine what symptoms appear and what long-term effects may follow.

It’s worth noting that recent research has helped clarify older assumptions about birth trauma. For example, studies now show that assisted vaginal delivery with forceps or vacuum, by itself, is not an independent risk factor for stroke when other factors are properly accounted for.

Perinatal Stroke

Stroke can happen to newborns, though many people don’t realize it. Perinatal stroke occurs when a blood clot blocks an artery carrying blood to the brain (arterial ischemic stroke) or when a clot forms in the veins that drain blood from the brain (cerebral sinovenous thrombosis).

Together, these stroke types account for about 10 to 15 percent of brain injuries in full-term infants. Babies who have had a stroke often develop seizures in the first days of life. Some show weakness on one side of the body. Others may not show clear symptoms until months later, when parents notice developmental delays or early signs of cerebral palsy.

Brain Injury From Infection And Inflammation

Infections and inflammatory processes before or around birth can directly damage a developing brain. They can also make the brain more vulnerable to injury from lack of oxygen.

Maternal infections, prolonged rupture of the amniotic sac, fever during labor, and inflammation in the placenta or umbilical cord all increase the risk of brain injury. After birth, serious bacterial infections (sepsis) and meningitis can cause or worsen neurological problems.

Research shows that inflammation in the fetal tissues, visible on examination of the placenta and umbilical cord, is an independent risk factor for developing brain injury, even when accounting for other complications during delivery.

Metabolic And Other Causes

Other conditions can cause or contribute to brain injury around birth:

• Severely low blood sugar (hypoglycemia), especially if it goes untreated
• Genetic metabolic disorders that affect how the body processes nutrients
• Inherited epilepsy syndromes
• Structural brain malformations present before birth

Sometimes these conditions exist alongside oxygen deprivation or infection, making diagnosis more complex. That’s why newborns with signs of brain injury undergo thorough testing to identify all contributing factors.

What Medical Complications Can Lead To Birth Injuries?

Birth-related brain injuries rarely have a single cause. They typically result from a combination of factors involving the mother’s health, events during labor and delivery, and the baby’s condition.

Pregnancy And Labor Complications

Certain complications during pregnancy and labor significantly increase the risk of brain injury:

• Pregnancy lasting longer than 41 weeks
• Prolonged rupture of membranes before labor begins
• Abnormal fetal heart rate patterns during labor
• Thick meconium (the baby’s first stool) in the amniotic fluid, which can be inhaled
• Sudden emergencies like placental abruption (the placenta separating early), uterine rupture, or umbilical cord prolapse
• Shoulder dystocia, where the baby’s shoulder gets stuck during delivery
• Tight nuchal cord (umbilical cord wrapped around the baby’s neck)
• Prolonged or obstructed labor, particularly without adequate fetal monitoring
• Failed assisted delivery attempts with vacuum or forceps

Studies from diverse populations consistently identify these risk factors. For instance, research in Uganda found that obstructed labor, lack of proper fetal monitoring during labor, and acute emergencies were all strongly associated with brain injury in newborns.

Maternal Health Conditions

A mother’s health before and during pregnancy also plays a role:

• High blood pressure and preeclampsia
• Diabetes, particularly when blood sugar is poorly controlled
• Maternal obesity
• Blood clotting disorders (thrombophilias)
• Inadequate prenatal care
• Chronic illnesses that aren’t well managed during pregnancy

These conditions can affect how well the placenta functions, how the baby grows, and how labor progresses, all of which influence brain injury risk.

Baby-Specific Risk Factors

Characteristics of the baby also matter:

• Very low birth weight (less than 3.3 pounds)
• Premature birth, especially before 32 weeks
• Male sex (some studies show boys have higher risk)
• Low Apgar scores at 5 and 10 minutes after birth
• Small size for gestational age

These factors don’t cause brain injury directly, but they indicate vulnerability. Premature babies, for example, have fragile blood vessels in the brain that bleed more easily, and their developing brains are particularly sensitive to oxygen changes and infection.

After Birth

Even after delivery, certain problems can cause new brain injury or worsen existing damage:

• Unrecognized or untreated seizures
• Low blood pressure or inadequate oxygen levels
• Serious infections or sepsis
• Extreme levels of carbon dioxide from breathing problems
• Severe jaundice (high bilirubin) that goes untreated

Inflammation throughout the body, whether from infection, excessive oxygen exposure, or severe stress, also contributes to ongoing brain injury after birth.

How Do Doctors Diagnose Brain Injuries In Newborns?

When doctors suspect a baby has experienced a brain injury, they begin a careful, systematic evaluation.

Initial Clinical Assessment

The medical team starts by gathering detailed information about the pregnancy and delivery. They review whether there were any sudden emergencies, signs of infection, maternal health problems, or complications during labor. They note Apgar scores (the standard assessment of a baby’s condition at 1 and 5 minutes after birth), cord blood gas results that show oxygen and acid levels, and whether the baby needed resuscitation with breathing support or chest compressions.

Doctors then perform repeated neurological examinations. They check the baby’s level of alertness, muscle tone, reflexes, and whether seizures are occurring. For babies with suspected HIE, they often use the Sarnat staging system to classify the severity of brain dysfunction.

Brain Imaging

MRI (magnetic resonance imaging) is the gold standard for identifying and characterizing brain injuries in newborns. It can show patterns of damage from lack of oxygen, locate areas of bleeding or stroke, and help predict long-term outcomes. Advanced techniques like MR spectroscopy can even show chemical changes in brain tissue that indicate injury.

According to guidelines from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), MRI evidence of brain injury consistent with oxygen deprivation is one of the key criteria used to determine whether a baby’s neurological problems are related to events during labor and delivery.

Continuous Brain Monitoring

Many newborns with suspected brain injury undergo continuous EEG (electroencephalogram) monitoring or simplified versions like amplitude-integrated EEG. These tests track the brain’s electrical activity and can detect seizures that aren’t obvious from watching the baby. They also help doctors assess the overall health of brain function and predict recovery.

Some advanced centers, including Mount Sinai in New York, are developing sophisticated monitoring tools that use computer analysis of infant movements combined with video and EEG to detect subtle neurological changes and assess how babies are responding to treatments like therapeutic hypothermia.

Laboratory And Additional Tests

The workup typically includes:

• Blood gas measurements and lactate levels
• Tests for infection (blood cultures, inflammatory markers)
• Microscopic examination of the placenta
• Assessment of heart, kidney, and liver function, since severe brain injury often affects multiple organs
• New York’s required newborn metabolic screening, which can identify genetic disorders that cause or mimic brain injury

Researchers are also studying biomarkers in the blood, like troponin I (a heart injury marker), to help predict which babies with HIE will have worse outcomes even with cooling treatment.

What Treatments Are Available For Birth-Related Brain Injuries?

Immediate Care And Resuscitation

The first minutes after birth are critical. The American Academy of Pediatrics and American Heart Association publish detailed guidelines, most recently updated in 2025, that guide healthcare teams through newborn resuscitation. The priorities are clear: establish effective breathing, maintain a normal heart rate, and keep the baby warm.

Current guidelines emphasize that breathing support is the top priority for newborns in distress. They also include updated recommendations about umbilical cord management, with evidence showing that delayed cord clamping or other strategies can improve outcomes, particularly for very premature babies by reducing brain bleeding.

High-quality resuscitation doesn’t reverse brain injury that has already occurred, but it prevents further damage and buys time for definitive treatments.

Therapeutic Hypothermia For HIE

Therapeutic hypothermia, commonly called cooling, is the first and currently only proven treatment that protects the brain after HIE. The standard protocol involves cooling the baby’s entire body (or just the head in some centers) to 33 to 34 degrees Celsius for 72 hours. Treatment must begin within 6 hours of birth to be effective.

Multiple large randomized trials and combined analyses of those trials have demonstrated that cooling reduces the combined risk of death or moderate to severe disability. On average, treating seven babies with cooling prevents one case of death or major disability. While those numbers may sound modest, they represent meaningful progress for a condition that previously had no specific treatment.

Cooling works by slowing down the harmful chemical reactions that occur during the secondary energy failure phase. It cannot undo damage that has already happened, which is why starting treatment quickly matters so much.

Babies undergoing hypothermia receive intensive monitoring in a neonatal intensive care unit (NICU). Complications like slow heart rate, low platelet counts, and pulmonary hypertension can occur during cooling, but experienced NICU teams manage these problems routinely.

After 72 hours, the baby is slowly rewarmed over several hours. Careful attention to the rewarming process helps avoid triggering new problems.

Managing Seizures And Supporting Recovery

Alongside cooling, NICU teams focus on:

• Identifying and treating seizures promptly, usually starting with phenobarbital and adding other anti-seizure medications if needed
• Maintaining optimal oxygen levels and blood pressure to protect injured brain tissue
• Providing careful fluid and nutrition management
• Monitoring and treating low blood sugar
• Treating infections aggressively
• Managing pain and sedation, especially during the cooling period

A 2023 review of clinical practice guidelines found that high-quality protocols now cover all aspects of HIE care, from deciding which babies should receive cooling to timing brain imaging and planning long-term follow-up.

Experimental And Emerging Treatments

Researchers are actively studying additional therapies that might be combined with cooling to further improve outcomes. These include:

• Erythropoietin (EPO), a hormone that may protect brain cells
• Magnesium sulfate
• Xenon gas given during breathing support
• Melatonin
• Stem cell therapies

Other areas of investigation include optimizing vitamin D levels (many newborns with HIE have low vitamin D, which may affect inflammation) and using near-infrared spectroscopy to non-invasively monitor oxygen delivery to the brain.

As of 2025, these approaches remain investigational. The current standard of care is therapeutic hypothermia combined with comprehensive intensive care.

Where Treatment Happens In New York

The quality of care a baby receives, and where that care is provided, significantly affects outcomes. The American Academy of Pediatrics recommends that very premature babies and those with very low birth weights be delivered at, or quickly transferred to, Level III or IV NICUs. Strong evidence shows these babies have better survival and fewer long-term problems when cared for in these specialized units from birth.

New York operates a regionalized perinatal care system designed to match the level of care to the level of risk. The system includes:

• Level I and II hospitals that care for normal or moderately high-risk pregnancies and healthy newborns
• Level III and Regional Perinatal Centers that provide the most advanced maternal and newborn intensive care

Regional Perinatal Centers in New York, such as Albany Medical Center and Mount Sinai Kravis Children’s Hospital, offer therapeutic hypothermia, advanced brain monitoring, high-risk infant follow-up programs, and specialized expertise in managing complex neurological conditions. New York’s regulations (codified in 10 NYCRR 405.21) formalize this system to ensure babies receive appropriate, timely care.

What Long-Term Effects Can Birth-Related Brain Injuries Cause?

Immediate And Long-Term Outcomes

The long-term effects of birth-related brain injuries depend on the type and severity of injury and how quickly treatment began.

Babies with mild HIE typically do well, with most developing normally. Moderate and severe HIE carry higher risks of death or significant disability, even with cooling treatment. Among survivors with severe initial injury, cerebral palsy, intellectual disability, epilepsy, vision or hearing problems, and behavioral challenges remain common.

Long-term outcome data show that while therapeutic hypothermia has improved the odds, it hasn’t eliminated the risk of disability. That’s why research continues into additional treatments and why comprehensive follow-up care is so important.

Children who experienced oxygen deprivation, low birth weight, prematurity, or low Apgar scores at birth face increased risks of developing epilepsy later in childhood, especially if they experience additional injuries like head trauma.

Why High-Risk Infant Follow-Up Programs Matter

Medical guidelines strongly emphasize the need for structured, long-term follow-up for babies who experienced HIE, extreme prematurity, significant brain bleeding, or stroke.

New York’s Regional Perinatal Centers and major children’s hospitals run dedicated high-risk infant follow-up programs. These clinics:

• Regularly assess growth, nutrition, and feeding
• Monitor cognitive, language, and motor development
• Screen for vision, hearing, and movement disorders
• Coordinate physical, occupational, and speech therapy
• Connect families with Early Intervention services
• Support parents in understanding and accessing medical and developmental resources

Starting interventions early, during critical periods of brain development, gives children the best chance to reach their full potential. These programs also provide parents with guidance, support, and a consistent medical home as they navigate complex care needs.

How Can Birth-Related Brain Injuries Be Prevented?

Risk-Appropriate Perinatal Care

The most effective prevention strategy is ensuring that mothers and babies receive care in the right setting for their level of risk. This concept, called risk-appropriate care, is a cornerstone of modern perinatal medicine.

Studies consistently show that very low birth weight infants and very premature babies have significantly better survival and fewer complications, including brain injuries, when born in Level III or IV NICUs rather than lower-level hospitals.

New York’s regionalized perinatal care system, established through state regulations and coordinated by regional perinatal networks, works to match risk with resources. The system encourages prenatal identification of high-risk conditions and either planned delivery at an appropriate center or rapid transfer after birth.

Evidence-Based Obstetric Care

Obstetric practices that reduce brain injury risk include:

• Comprehensive prenatal care with management of high blood pressure, diabetes, infections, and other maternal conditions
• Monitoring fetal growth and well-being throughout pregnancy
• Following evidence-based guidelines for fetal heart rate monitoring during labor
• Rapid response to obstetric emergencies like placental abruption, uterine rupture, and cord prolapse
• Protocols to prevent, recognize, and manage shoulder dystocia
• Infection prevention strategies, including Group B Streptococcus screening and treatment, antibiotics for prolonged membrane rupture, and management of maternal fever
• Appropriate timing of delivery when pregnancy complications develop

At delivery, following the most current neonatal resuscitation guidelines helps minimize injury and optimize early care.

Preventing Injury After Birth

While not technically perinatal, abusive head trauma in the first months of life is a major cause of brain injury in infants. Research shows that parent education programs delivered in maternity units can reduce these injuries.

One successful approach involves nurses providing education along with written materials immediately after birth, teaching parents about normal infant crying patterns, soothing strategies, and the dangers of shaking. This simple intervention, when delivered universally, has been shown to reduce both self-reported shaking behavior and actual cases of abusive head trauma.

What Does The Data Show About Birth Outcomes In New York?

New York has made significant progress in perinatal care over recent decades. While state-level data focuses more on prematurity and infant mortality than on specific brain injury rates, these measures reflect the broader context in which brain injuries occur.

The 2024 March of Dimes Report Card shows New York’s preterm birth rate at 9.5 percent, placing the state among those with relatively better outcomes. Leading causes of infant death in New York include complications of prematurity and low birth weight as well as congenital anomalies, both of which are closely tied to brain injury risk.

New York’s Title V Maternal and Child Health programs track performance measures relevant to brain injury prevention, including the percentage of very low birth weight infants born in Level III or higher NICUs and the timeliness of newborn screening. State programs also work to reduce racial and ethnic disparities in outcomes, recognizing that systemic inequities in healthcare access and quality contribute to preventable injuries.

What Support Is Available For Families?

Birth-related brain injury affects entire families. Parents face not only the medical complexities of caring for an injured newborn but also profound emotional challenges, uncertainty about the future, and the need to navigate unfamiliar healthcare and social service systems.

High-quality medical care includes family-centered support that addresses all these needs:

• Clear, honest, compassionate communication about diagnosis, treatment, and what to expect
• Inclusion of parents in medical rounds and care planning decisions
• Early referrals to Early Intervention programs (available in every county in New York for children from birth to age three)
• Connections to developmental pediatricians, pediatric neurologists, physical medicine and rehabilitation specialists, audiologists, and ophthalmologists as needed
• Ongoing coordinated follow-up through NICU and high-risk infant clinics
• Psychological support for parents, recognizing that prolonged NICU stays, watching a baby undergo treatments like cooling, and facing an uncertain future cause significant stress and trauma

Many Regional Perinatal Centers in New York have social workers and family support specialists who help families understand available resources, apply for services, and find community support.

Parents often find value in connecting with other families who have been through similar experiences. National and local organizations provide support groups, educational resources, and advocacy opportunities.

Taking The Next Steps After A Birth Injury

Birth-related brain injuries represent some of the most challenging situations in newborn medicine. While the medical field has made real progress, particularly with therapeutic hypothermia for HIE, these injuries continue to affect thousands of families each year.

Understanding the medical facts helps families make informed decisions, ask the right questions, and advocate effectively for their child. Knowing what treatments are available, what outcomes are possible, and what resources exist can provide some sense of control during an overwhelming time.

If your family is facing a birth-related brain injury, you don’t have to navigate the journey alone. Medical teams, early intervention programs, developmental specialists, and family support services are all part of the network of care available in New York. Taking advantage of high-risk follow-up programs and starting therapies early gives your child the best opportunities for development and growth.

*This page provides educational information based on current medical evidence and guidelines. It is not a substitute for individualized medical advice from your child’s healthcare team.