Posts Tagged ‘ brain injuries ’

Brain Injuries at Birth Have Many Causes, Report Finds

Tuesday, May 6th, 2014

Brain injuries suffered by newborns at the moment of their birth have long been thought to be the result of insufficient oxygen during delivery, with doctors often held responsible by parents.  But a new report by a committee of experts in obstetrics, pediatrics, neurology and fetal-maternal medicine has found that the full cause of such injuries, which can result in serious complications, are far more complex than that.  The New York Times has more:

The document, called Neonatal Encephalopathy and Neurologic Outcome, updates a version published in 2003 that focused on oxygen deprivation, or asphyxia, around the time of birth. The new report, which highlights significant advances in diagnosis and treatment in the decade since, was published by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. Brain injuries affect about three in 1,000 babies born full-term in the United States, but only half of these cases are linked to oxygen deprivation during labor and delivery, according to the new report. And even in those instances, a problem that occurred long before birth might have exaggerated the effects of a reduced oxygen supply that would have not otherwise caused a lasting brain injury.

According to the 2003 report, fewer than 10 percent of children with cerebral palsy, the most severe such brain injury, showed signs of asphyxia at birth. Unless certain clear-cut symptoms are present then, brain abnormalities are probably not the result of a complication during labor or delivery, the new report states.

Rather, there may be other reasons for neonatal encephalopathy, as brain disorders in full-term newborns are called. These include genetic factors and maternal health problems like hypothyroidism, placental abnormalities, major bleeding during pregnancy, infection of the fetal membranes and a stroke in the baby around the time of birth.

“We know that neonatal encephalopathy has a variety of causes, and we hope this report will enable us to provide more accurate information to affected families and devise better methods of prevention and treatment,” said Dr. Mary E. D’Alton, chief of maternal-fetal medicine at Columbia University Medical Center, who was chairwoman of the task force.

Neonatal encephalopathy is a syndrome of disturbed neurological function that occurs in full-term baby’s first days. It is characterized by impaired consciousness or seizures, often accompanied by breathing difficulties and poor muscle tone and reflexes.

To determine whether an insufficient supply of oxygen and blood during labor and delivery is the likely cause, several factors should be considered together. These include a low Apgar score at 5 and 10 minutes after birth; high acid level (called acidemia) in the umbilical artery; major organ failure; and an M.R.I. scan showing a particular pattern of cerebral injury, according to the new report.

The more of these conditions that are present, the more likely that insufficient oxygen during the birth was responsible for the injury.

Reassuringly, the report pointed out that most infants with low Apgar scores will not develop cerebral palsy. “Even in the presence of significant acidemia, most newborns will be neurologically normal,” the committee said. (A doctor evaluates a newborn on five criteria to arrive at the Apgar score, a fast way to gauge the baby’s well-being.)

The experts noted that “there are multiple potential causal pathways that lead to cerebral palsy in term infants, and the signs and symptoms of neonatal encephalopathy may range from mild to severe, depending on the nature and timing of the brain injury.”

For example, the injury might occur as a result of risk factors at the time of conception or from conditions that develop during pregnancy, like fetal growth retardation or placental lesions.

At this time, there are few effective remedies for those problems, but if certain abnormalities in the fetal heart rate are present when a woman goes into labor, the doctor may be able to prevent a serious brain injury by doing a cesarean delivery.

Add a Comment

Researchers Call for ‘Hit Limit’ to Minimize Concussions

Monday, February 6th, 2012

Baseball players have long been given a “pitch count,” a number of pitches they are allowed to throw before they must rest their arms and shoulders.  Now researchers are saying that young athletes who participate in contact sports, chiefly football, should have a similar “hit count” to minimize the number of slams and tackles–and concussions–their brains endure.

CNN.com‘s “The Chart” blog has more reports:

The adolescent football player’s brain is rattled an average of 650 times per season. That’s just an average. There are positions on the football field where the numbers approach 1,000 hits to the head.  And while a small fraction of those hits actually lead to a diagnosable concussion, the concern is that sub-concussive damage – the menacing smaller blows that add up during practices and games – could be as bad, or worse, for the brain.

With those sobering stats in mind, the Sports Legacy Institute [SLI] Friday called for the adoption of a “Hit Count” – similar to the “Pitch Count” system used in baseball – for youth athletes participating in contact sports.

“In baseball you have a pitch count because research showed that the more times you threw in a day or during the season, the more risk that you would wear out the elbow,” said Chris Nowinski, president and CEO of the SLI, a sports research advocacy group. “Trauma to the head can wear out the brain. So if you’re going to limit trauma for elbows, then you should also limit it for the brain.”

The SLI is proposing a 1,000 hit-per-season limit for young athletes, as well as a 2,000 hit-per-year cap.

The idea behind the hit count may sound simple, but implementation could pose a challenge. The idea of changing any sport, especially football, is bound to have detractors. But resistance to rule changes at the NFL level gradually waned, and Nowinski hopes that the same might happen at the youth level.

“You’ve got the toughest men in the room [NFL players] saying there is no such thing as a tough brain,” said Nowinski. “If the NFL is willing to do that, then we should do that for kids as well.”

Image: Kid in football gear, via Shutterstock

Add a Comment

Studies Investigate Relationship Between Brain Injury, Child Development

Monday, January 23rd, 2012

Traumatic Brain Injuries (TBI) and child development are the subjects of two small studies published in the journal Pediatrics this week.  CNN.com reports on the findings:

The first study compared the social, intellectual, and behavioral functions of 53 children who had experienced a traumatic brain injury before the age of three, most of which were the result of falls, with 27 children of the same age who had never sustained a TBI.

The authors write that while a severe TBI was associated with lowered intellectual function, the socioeconomic status of the child’s family may be a more powerful predictor of the child’s intellectual development.  They cannot fully explain why, but they suggest lower socioeconomic status, high parental stress and low parental involvement has an effect on a child’s recovery.

The study also found that mild, less traumatic injuries, similar to those commonly sustained from short falls, had no negative effect on any of the child’s functions.

The second prospective study, which was conducted at the same children’s hospital in Australia, looked at 40 children who had sustained a TBI at some point between the ages of two and seven.

More of the injuries were sustained from motor vehicle or pedestrian accidents than were in the first study and therefore the children had more severe TBIs in this study. The researchers examined the children immediately after the injury, and then again 12 months, 30 months, and ten years later.

Children in this study who suffered a mild traumatic injury recovered well and didn’t face a dramatic deficit in their intellectual abilities, similar to what was seen in the first study. Researchers also found children with severe TBI had problems with their intellectual, behavioral, and social development. More specifically, children with severe traumatic brain injuries seemed to lag behind their peers in intellectual development for upwards of three years after their injury.

Image: Young boy in a hospital bed, via Shutterstock.

Add a Comment

Research Raises Concerns About Heading Soccer Balls

Thursday, December 8th, 2011

A new study of the brains of experienced soccer players–adults who have played the game since childhood–has concluded that repeated heading of the ball has pronounced effects on brain functions including memory and attention.  The New York Times reports:

The researchers found, according to data they presented at a Radiological Society of North America meeting last month, that the players who had headed the ball more than about 1,100 times in the previous 12 months showed significant loss of white matter in parts of their brains involved with memory, attention and the processing of visual information, compared with players who had headed the ball fewer times. (White matter is the brain’s communication wiring, the axons and other structures that relay messages between neurons.)

This pattern of white matter loss is “similar to those seen in traumatic brain injury,” like after a serious concussion, the researchers reported, even though only one of these players reported having ever experienced a concussion.

The players who had headed the ball about 1,100 times or more in the past year were also substantially worse at recalling lists of words read to them, forgetting or fumbling the words far more often than players who had headed the ball less often.

“Based on these results, it does look like there is a potential for significant effects on the brain from frequent heading,” says Dr. Michael L. Lipton, associate director of the Gruss Magnetic Resonance Research Center at Einstein and senior author of the study.

Image: Boy with a soccer ball, via Shutterstock

Add a Comment

CDC: Traumatic Brain Injuries Up 60 Percent Among Children

Thursday, October 6th, 2011

The Centers for Disease Control and Prevention is reporting that emergency room visits for sports- and recreation-related traumatic brain injuries, or TBIs, increased among children by 60 percent over the last decade.

The number of injuries rose from 153,375 in 2001 to 248,418 in 2009, researchers found, mostly following accidents during bicycling, football, playground activities, basketball, and soccer.

The CDC says that the rise in number may not be due to changes in how children play sports or use playground equipment.  Instead, researchers attribute the increase to a raised awareness among parents, coaches, and the general public of the importance of seeking medical care after a head injury.

Children may be more vulnerable to long-term effects of TBIs than adults. TBI symptoms may appear mild, researchers say, but the injury can lead to significant life-long impairment affecting an individual’s memory, behavior, learning, and/or emotions. Appropriate diagnosis, management, and education are critical for helping young athletes with a TBI recover quickly and fully.

“While some research shows a child’s developing brain can be resilient, it is also known to be more vulnerable to the chemical changes that occur following a TBI,” said Richard C. Hunt, M.D., director of CDC’s Division for Injury Response.

(image via: http://www.kob.com/)

Add a Comment