Anoxic brain injuries on MRI?

RNOTODAY, BSN, RN · Feb 27, 2007

Would this show up? Night shift had a baby brought in, delivered in the ambulance, breech, stuck for over 15 minutes. Got him back, transferred to tertiary care, no answers yet. There's got to be some damage, just wondering if it would show up on a scan.
My youngest was a buttling breech, firmly lodged in the outlet that way. I was not happy when the doc said I had to be sectioned. I saw him earlier today (he was involved in last night's case) and I thanked him.

yes, abi shows up on mri.....

burn out · Feb 27, 2007

I am just guessing but I would think that acute anoxic injury would show up but how this will manifest itself in the baby may take years to know for certain. My niece had numerous problems growing up , first they thought she had sucking problems then hearing and speech problems which all were dealt with we just didn't know why she was like this. Finally, at the age of 16 she started having tremors and drawing in of her left arm and leg and she was finally diagnosed with cerebral palsy. I asked my sister if my niece's birth was difficult and she said when she went to the hospital they said she was in false labor, put her in a room no monitors closed the door and no one checked on her again until 7am when she was crowning, her doctor would not even come in to the hospital. My niece is now 30 years old and still the cerebral palsy seems to be getting worse, she now needs a wheelchair to get around.

subee, MSN, CRNA · Feb 28, 2007

I am just guessing but I would think that acute anoxic injury would show up but how this will manifest itself in the baby may take years to know for certain. My niece had numerous problems growing up , first they thought she had sucking problems then hearing and speech problems which all were dealt with we just didn't know why she was like this. Finally, at the age of 16 she started having tremors and drawing in of her left arm and leg and she was finally diagnosed with cerebral palsy. I asked my sister if my niece's birth was difficult and she said when she went to the hospital they said she was in false labor, put her in a room no monitors closed the door and no one checked on her again until 7am when she was crowning, her doctor would not even come in to the hospital. My niece is now 30 years old and still the cerebral palsy seems to be getting worse, she now needs a wheelchair to get around.

I'm so sorry about your niece - I hope that she stabilizes with therapy. But in the interest of honesty, I must say that the minority of CP is now attributed to anoxic brain injury during delivery, but is acquired in utero. However, if her hospital care was truly as lackadaisical as your post indicated, who knows what happened during delivery? I'm keeping my fingers crossed that she will progress and have a good life.

RNOTODAY, BSN, RN · Feb 28, 2007

I am just guessing but I would think that acute anoxic injury would show up but how this will manifest itself in the baby may take years to know for certain. My niece had numerous problems growing up , first they thought she had sucking problems then hearing and speech problems which all were dealt with we just didn't know why she was like this. Finally, at the age of 16 she started having tremors and drawing in of her left arm and leg and she was finally diagnosed with cerebral palsy. I asked my sister if my niece's birth was difficult and she said when she went to the hospital they said she was in false labor, put her in a room no monitors closed the door and no one checked on her again until 7am when she was crowning, her doctor would not even come in to the hospital. My niece is now 30 years old and still the cerebral palsy seems to be getting worse, she now needs a wheelchair to get around.

Im so sorry about your niece... however, I cant help thinking that one of the hallmarks of cp, is that it does *not* get worse in progression.....For example, if the anoxia at birth caused , say, a child to have left sided weakness, then it would not progress to anything else, in other words, it does not get worse.... am I making sense?

Jolie, BSN · Feb 28, 2007

Tazzi,

Has the baby had a head U/S? If the baby is unstable (vented, for example) it may be difficult to do an MRI or CT scan, but an U/S can be done at the bedside, and is usually fairly well-tolerated, even with an unstable baby.

A head U/S would reveal bleeding, which is likely if the birth was very traumatic, and/or dilation of the ventricles, which sometimes occurs with bleeding. If any areas of infarction are seen on a head U/S done immediately after birth, they would indicate pre-natal injury, as it takes a few weeks for this type of insult to become visible on a neonatal cranial U/S.

Has this baby experienced any seizures? That would be a poor indicator.

My very best to this baby and family.

TazziRN, RN · Feb 28, 2007

No seizures but is very jittery whenever he's touched. Had a bedside sono, inconclusive. Would anoxia cause bleeding in a neonate? He's still vented but is trying to take breaths on his own.

burn out · Feb 28, 2007

Im so sorry about your niece... however, I cant help thinking that one of the hallmarks of cp, is that it does *not* get worse in progression.....For example, if the anoxia at birth caused , say, a child to have left sided weakness, then it would not progress to anything else, in other words, it does not get worse.... am I making sense?

Thank you for your concern. I know that it doesn't fit the typical cp presentation but she was thoroughly tested and this is the best they could come up with.

Was the baby listed by the op a term or premature baby. If it was term does it display the normal reflexes or is it too critical to say for sure. I don't like the fact about how jerky the baby is..just doesn't sound normal.

TazziRN, RN · Feb 28, 2007

Term. Came in with CPR in progress. I don't know about the reflexes but I'm thinking he's sedated since he's vented.

Jolie, BSN · Feb 28, 2007

No seizures but is very jittery whenever he's touched. Had a bedside sono, inconclusive. Would anoxia cause bleeding in a neonate? He's still vented but is trying to take breaths on his own.

Trauma would be a more likely cause of intracranial bleeding in a term baby.

Hypoxic-ischemic encephalopathy would be the primary concern in a baby who required extensive resuscitation at birth, and if this baby has experienced this, it may be awhile before the full extent of his problems are known. I'm not encouraged to hear that he continues to require ventilation, or that he is "hyper-sensitive" to touch.

Is he able to maintain a normal temperature? Does he exhibit a normal suck?

TazziRN, RN · Feb 28, 2007

Temp, I don't know. He's vented, so he can't suck.

Jolie, BSN · Feb 28, 2007

Temp, I don't know. He's vented, so he can't suck.

Even vented babies can and do suck. Not on a bottle, obviously, but on the ETT, a pacifier, or finger. Babies with hypoxic brain injury often exhibit either a hyper suck reflex, or none at all.