Determining the Timing of a Brain Injury in the Newborn: What We Can Learn from Brain Imaging – Part Two

A brain imaging study, such as an ultrasound, CAT scan, or MRI, can help answer questions about the timing of a birth injury. One of the issues commonly argued in medical-legal cases involving an infant asphyxiated at birth is whether a brain injury occurred before or during labor and delivery.

In an infant hypoxic-ischemic event (link to Part One here), the brain can be damaged from a lack of blood and oxygen. It takes some hours for this type of event to appear on brain imaging. This means that if a CAT scan is done two hours after delivery and the results reveal a well-developed brain injury, it is likely the injury occurred before labor and delivery.

If an infant experiences asphyxia during labor and delivery, changes in the brain will appear on imaging studies within the first twenty-four hours. The infant’s brain will swell and compress fluid-filled cavities, also called ventricles, causing them to appear slit-like on imaging. The swelling will peak at about two to three days after the infant’s birth and will be gone after one week. Thereafter, the brain may appear normal for some period of time. For example, if brain imaging is done around the tenth day of life, the results may appear normal. This does not necessarily rule out the possibility that a brain injury occurred during labor and delivery.

When the infant reaches two to three weeks of life, brain imaging will begin to reveal telltale signs of damage caused by asphyxiation during delivery. Imaging will reveal cavitation, or loss of brain matter, which tends to worsen over time. The ventricles will then grow larger as brain matter is replaced by fluid. An infant with this condition may suffer from physical and intellectual impairment.

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