Birth-related brain injuries may be far more common than we previously thought, according to a team of English researchers based at Imperial College London.
In a new, first-of-its-kind study, public health experts have used exhaustive data from the United Kingdom’s National Health Service to estimate the incidence of diagnosed conditions and symptoms associated with perinatal brain injuries, forms of harm occurring at or soon after a child’s birth.
Brain Injuries In Full-Term, Preterm Infants
The results are somewhat staggering. Over 5 in every 1,000 babies born in the United Kingdom are affected by some form of early brain injury, the team’s new study estimates.
Looking deeper into the numbers, the group found a drastic disparity in the rate of brain injury symptoms between full-term and preterm infants (babies born at or before 37 weeks of gestation). While around 3.5 in every 1,000 full-term babies are impacted by a brain injury, nearly 26 in every 1,000 preterm infants develop signs or conditions associated with neurological harm. In short, preterm babies are over 7-times more likely to have a perinatal brain injury than full-term infants.
“Brain injury at or soon after birth is a serious problem,” according to Chris Gale, the study’s lead author, “as it can lead to long-term conditions later in life such as cerebral palsy, blindness deaf and learning deficits.”
A New Definition For Birth-Related Brain Injuries
Doing this sort of research in the past was difficult, says Neena Moodi, a professor of neonatal medicine at Imperial College Medicine, because the UK’s public health system had no consistent definition for child brain injuries and collected no rigorous data on the issue.
Associated Signs & Conditions
Developing a consistent definition is still hard, since many effects of brain injuries only become apparent after a child has begun to age. To tackle the problem in a more-comprehensive way, a team of specialists gathered by England’s Department of Health turned to symptoms and conditions that are usually linked to a brain injury, including:
- Clinical signs of oxygen deprivation
- Seizures and tremors
- Bleeding in the brain
- Stroke directly prior to birth or soon after birth
- Meningitis and other infections
- Kernicterus (a severe form of jaundice)
- cystic periventricular leucomalacia (in preterm infants
Imperial College London’s new study is the first research project to use this new definition of brain injury, which focuses on related symptoms, rather than a full clinical work-up, to capture the incidence. “We have devised a practical way to measure the incidence rate of brain injury in babies,” Chris Gale, who spoke with Imperial College London’s news service.
“This measure will also help us to evaluate other interventions, for example, making sure that as many preterm babies as possible are born at hospitals with advanced neonatal services on site, which we know reduces the risk of brain injury.”
Birth Asphyxia & Brain Bleeds
During their investigation, the researchers also discovered which medical conditions contributed the most to brain injuries, ScienceDaily reports.
Hypoxic-ischemic encephalopathy, or HIE, was particularly prevalent in full-term infants. HIE is a condition caused by a lack of oxygen to the brain, accompanied by a fall in blood pressure. In preterm babies, periventricular hemorrhage, in which bleeding occurs around or inside the brain’s ventricle system, was most common.
Collecting Better Data
The study is also unique because researchers were able to use data on day-to-day clinical practice from the National Neonatal Research Dataset, a database that has collected data from every neonatal care unit in England, Wales and Scotland since 2012.
It’s an astounding amount of information. Records from 80,000 new patients are added every year, to say nothing of updates to existing patient records. The dataset’s true power, however, may lie in the fact that it’s routine. Doctors and nurses aren’t asked to do anything special; they simply care for their patients as usual. Most previous studies weren’t done that way.
England Works Toward Safer Birth Care
England is taking birth injuries head-on. In our last article, we explained how the country’s National Health Service, under the guidance of Secretary Jeremy Hunt, had committed itself to the ambitious goal of reducing the number of brain-related birth injuries in half over the next two decades.
A bevy of new programs have already been started to achieve Hunt’s mission. In May of 2017, Secretary Hunt established the Rapid Resolution and Redress System, an optional alternative to the civil justice system for families and children who have been affected by avoidable birth injuries. Next, Secretary Hunt empowered the UK’s Healthcare Safety Investigation Branch to conduct independent inquiries into serious unexplained birth injury cases. And now, the United Kingdom has a new definition for neonatal brain injuries, one that should help medical providers identify children who could benefit from intervention more readily.
All of these new initiatives are an attempt, according to the National Maternity Review, to craft a “modern maternity service that delivers safer, more personalised care for all women and every baby.”