Other Birth Injuries

When a baby is born, most families expect a healthy outcome. But sometimes, even with skilled care, unexpected injuries can occur during labor and delivery. While conditions like cerebral palsy and Erb’s palsy are more widely recognized, there exists a range of less common birth injuries that affect far fewer newborns but can still have significant effects on a child’s health and development.

Understanding these rare injuries matters. When families know what to look for and what questions to ask, they can advocate more effectively for their child’s care and make informed decisions about treatment and follow-up. This page explains some of the rarer types of birth injuries, how they happen, what symptoms to watch for, and what kinds of treatment and support are available.

What Makes a Birth Injury “Rare”

Most birth injuries are uncommon, affecting fewer than 2 in every 1,000 live births in the United States. Thanks to advances in obstetric and neonatal care, the rate of serious birth trauma has declined significantly over the past few decades.

The injuries described on this page are even less frequent than the more widely known conditions. Some occur in fewer than 1 in 10,000 births. They are typically associated with complicated or prolonged labor, difficult fetal positioning, abnormally large babies, or medical emergencies during delivery.

Even though these injuries are rare, they are real. Families facing them deserve clear information and access to the right medical resources.

Types of Rare Birth Injuries

Brain and Central Nervous System Injuries

Epidural Hemorrhage

An epidural hemorrhage is bleeding between the skull and the outer membrane surrounding the brain. In newborns, this is uncommon. It usually happens alongside a linear skull fracture, often in the area around the side or top of the head. If not detected and managed quickly, it can lead to serious neurological problems.

Symptoms may include changes in muscle tone, irritability, seizures, or abnormal breathing patterns. Diagnosis typically involves imaging such as an ultrasound or CT scan, and treatment may require close monitoring or surgical intervention depending on the severity.

Subgaleal Hemorrhage

This injury involves bleeding between the scalp and the skull, in a layer of tissue called the galea aponeurotica. It is most often associated with vacuum-assisted deliveries.

Subgaleal hemorrhage can be life-threatening because the space involved is large, and a newborn can lose a dangerous amount of blood into this area. Babies may show signs of shock, including pale or mottled skin, low blood pressure, difficulty breathing, and a rapidly spreading soft swelling across the scalp.

This condition requires immediate medical attention, including blood transfusions and intensive monitoring. The incidence is estimated at about 0.1 to 0.2 per 1,000 live births.

Kernicterus

Kernicterus is a rare but severe form of brain damage caused by untreated or poorly managed extreme jaundice in newborns. When bilirubin, a yellow pigment produced during the normal breakdown of red blood cells, reaches very high levels, it can deposit in the brain and cause permanent injury.

The incidence is approximately 1 in 100,000 births. With proper screening and treatment of newborn jaundice, kernicterus is largely preventable.

Effects of kernicterus can include hearing loss, problems with movement and muscle control, intellectual disability, and vision or dental issues. Early recognition and treatment of severe jaundice with phototherapy or exchange transfusion are critical to preventing this outcome.

Nerve Injuries

Phrenic Nerve Injury

The phrenic nerve controls the diaphragm, the main muscle used for breathing. Injury to this nerve can happen during a difficult delivery when there is excessive stretching or pulling on the baby’s neck.

Phrenic nerve injury is rare, affecting about 0.6% of infants with birth-related head or neck trauma. Babies with this injury may have trouble breathing, particularly when lying flat, and may show a raised shoulder or asymmetric chest movement.

Diagnosis is usually made with a chest X-ray showing an elevated diaphragm on one side, sometimes confirmed with ultrasound or nerve studies. Treatment depends on severity and may include positioning, breathing support, and in some cases, surgical repair. Many cases improve over time with supportive care.

Laryngeal Nerve Injury

The laryngeal nerve controls the vocal cords. Injury to this nerve is extremely rare but can occur with significant traction during delivery. Affected babies may have a weak, hoarse cry or difficulty with feeding and breathing.

Most cases are detected shortly after birth. Evaluation by an ear, nose, and throat specialist and sometimes imaging or direct visualization of the vocal cords can confirm the diagnosis. Some injuries resolve on their own, while others may require surgical intervention or long-term voice therapy.

Facial Nerve Palsy (Atypical Cases)

Facial nerve injury is more commonly seen with forceps deliveries but can also happen with prolonged labor or unusual fetal positioning. While many cases of facial palsy are temporary and resolve within weeks, some are more complex and persistent.

A baby with facial nerve injury may have asymmetry when crying, difficulty closing one eye, or trouble with feeding. Most infants recover fully, but if the injury is severe, physical therapy, eye protection, or surgery may be needed.

Musculoskeletal and Spinal Injuries

Clavicle and Skull Fractures (Atypical Locations)

Clavicle fractures are relatively common and usually heal quickly without complications. However, fractures in unusual locations or multiple fractures are less common and may signal a more difficult delivery or underlying risk factors.

Most clavicle fractures are diagnosed by physical exam or X-ray and are treated with gentle handling and positioning. Healing typically occurs within a few weeks with no lasting effects.

Spinal Cord Injury

Spinal cord injury in newborns is exceptionally rare, occurring in about 1 in 29,000 births, but it is one of the most serious birth injuries. It is usually associated with severe dystocia, breech delivery, or hyperextension of the baby’s neck during delivery.

Symptoms can range from muscle weakness and reduced movement to complete paralysis and respiratory failure. Diagnosis requires imaging such as MRI, and treatment involves stabilization, respiratory support, and long-term rehabilitation.

The prognosis depends on the level and extent of the injury. Some infants may regain function with therapy, while others may have a permanent disability requiring lifelong medical and supportive care.

Nasal Septal Dislocation

The nasal septum is the cartilage that divides the nostrils. Dislocation of this structure during birth is uncommon, affecting about 0.6% of newborns with birth trauma, but it is often missed.

Signs include difficulty breathing through the nose, asymmetry of the nostrils, or feeding problems. If diagnosed early, it can often be repositioned without surgery. If left untreated, it may lead to long-term breathing or cosmetic issues.

Airway and Vascular Complications

Congenital High Airway Obstruction Syndrome (CHAOS)

CHAOS is an extremely rare and life-threatening condition in which the baby’s airway is blocked before birth, often due to a structural abnormality. It requires specialized planning and delivery, sometimes using a procedure called EXIT (ex utero intrapartum treatment), in which the baby’s airway is secured while still attached to the placenta.

This condition is typically diagnosed before birth through ultrasound. Delivery must occur at a hospital with advanced neonatal and surgical capabilities, such as NYU Langone or other similar specialized centers. Outcomes depend on the cause and severity of the obstruction, as well as the readiness of the care team.

Birth-Associated Thrombotic Events or Limb Ischemia

Blood clots or reduced blood flow to a limb during or shortly after birth are uncommon but serious. They may be related to placental issues, maternal diabetes, or trauma during delivery.

Symptoms include swelling, discoloration, coolness, or reduced movement in an arm or leg. Diagnosis is made with ultrasound or other imaging, and treatment may involve blood thinners, supportive care, or surgery in severe cases.

Other Rare Injuries

Ocular Injuries

Eye injuries, including retinal hemorrhages or fractures of the bones around the eye, are rare. Retinal hemorrhages are more common and often resolve on their own, but they can sometimes indicate more serious head trauma.

An ophthalmologist should evaluate any suspected eye injury. Most resolve without lasting effects, but follow-up is important to ensure normal vision development.

Liver and Splenic Injury

Injury to the liver or spleen during birth is rare and usually associated with high-force instrumented deliveries or breech births. These organs can tear or bleed internally, leading to shock or anemia.

Signs include pallor, poor feeding, abdominal swelling, and unstable vital signs. Diagnosis involves blood tests and imaging. Treatment ranges from observation and transfusion to emergency surgery.

Fetal Lacerations or Amputation Injuries

In very rare cases, a baby may sustain cuts or more severe injuries during an emergency cesarean section, especially if there is abnormal positioning or urgent use of instruments.

These injuries are typically recognized immediately and treated with wound care or surgical repair. Long-term outcomes depend on the location and severity of the injury.

How These Injuries Are Prevented

Modern obstetric care has significantly reduced the risk of rare birth injuries. Prevention strategies include:

• Adherence to evidence-based labor and delivery protocols established by organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP)
• Advanced fetal monitoring during labor
• Skilled and experienced obstetric and neonatal teams
• Use of alternative delivery methods when risk factors are identified
• Hospital safety initiatives and quality improvement programs

Leading medical centers in New York, including NYU Langone, Mount Sinai, Columbia, and Albany Medical Center, have implemented protocols and training programs designed to minimize preventable birth trauma.

Diagnosis and Treatment

Timely recognition of rare birth injuries is essential for the best possible outcomes. Diagnosis may involve:

• Physical examination by a neonatologist or pediatrician
• Imaging studies such as ultrasound, X-ray, CT, or MRI
• Neurologic assessment and monitoring
• Consultation with specialists in neurology, orthopedics, surgery, or other fields

Treatment varies widely depending on the type and severity of the injury. Some injuries, such as minor fractures or nerve palsies, may heal on their own with supportive care. Others, such as subgaleal hemorrhage, spinal cord injury, or airway obstruction, require immediate and aggressive medical or surgical intervention.

A multidisciplinary team approach is often needed, bringing together neonatologists, surgeons, neurologists, physical therapists, respiratory therapists, and social workers to coordinate care and support the family.

Recovery and Long-Term Outlook

The long-term prognosis for rare birth injuries depends on the specific condition, the promptness of treatment, and the child’s overall health.

• Many injuries, especially minor fractures and temporary nerve injuries, heal completely with no lasting effects.
• Some conditions, such as phrenic nerve injury or nasal septal dislocation, may require weeks to months of therapy or observation but often result in full recovery.
• More severe injuries, including spinal cord damage, kernicterus, or major hemorrhages, may lead to permanent disability, developmental delays, or the need for ongoing medical care and rehabilitation.

Families should maintain close follow-up with their pediatrician and any specialists involved. Early intervention services, physical and occupational therapy, and developmental support can make a meaningful difference in a child’s progress and quality of life.

Support for Families

Caring for a child with a rare birth injury can feel overwhelming. Families may face uncertainty about diagnosis, navigate complex medical systems, and manage emotional stress alongside the demands of newborn care.

Support is available through many channels:

• Hospital-based programs that include neonatology, surgery, neurology, audiology, respiratory care, and rehabilitation services
• Social workers and care coordinators who help families understand treatment options and access resources
• Parent education programs and peer support groups
• Early intervention programs that provide developmental services starting in infancy

NYBirthInjury.com exists to provide trusted, evidence-based information and to help connect families with qualified medical and support resources throughout New York and across the country.

What to Do After A Rare Birth Injury Diagnosis

Rare birth injuries are, by definition, uncommon. But for the families who experience them, they are deeply personal and often frightening. Understanding what these injuries are, how they are treated, and what kind of support is available can make a difficult situation more manageable.

If you believe your child has experienced a birth injury, trust your instincts. Seek medical evaluation promptly, ask questions, and advocate for your child’s care. You are not alone, and help is available. And if you believe your child’s birth injury resulted from medical negligence, don’t hesitate to reach out to us for legal help.