A skull fracture in anyone can be a serious injury, but in the vulnerable young brains of infants these injuries can be especially damaging. Exactly how common this type of birth is has not been accurately determined because it is not always easy to diagnose or recognize. Minor fractures that heal readily and cause few symptoms or complications may be much more common than has been reported in the literature.
The Newborn Skull
The skull of newborns is not the same as that of a child or adult. It is made up of several plates: two frontal bones, one occipital bone, and two parietal bones. These are knitted together by sutures, fibrous tissue that allows the plates of the skull to move and the overall skull to be more flexible as a newborn’s head is emerging from the birth canal. The sutures also serve to allow the skull to grow and expand as the brain grows. They fuse together as a child ages.
The nature of the newborn brain allows it to come through the birth canal more easily than if it were hardened and fused bone. On the other hand, the softer, more flexible skull of a newborn leaves the brain more exposed and vulnerable. If a fracture does occur, it has the potential to cause more damage and injury.
Causes of Fractures
Most causes of fractures in newborns result from the use of instruments during delivery. Instruments are more likely to be used during difficult labor, so skull fractures are more common when labor is difficult, goes on for a long time, or includes some type of complication. This could include an unusually large baby or a breech birth.
Instruments used by the person delivering the baby may include forceps and vacuum extractors. The doctor may use these instruments if delivery is difficult and the baby and mother need extra assistance. The instruments can easily cause the skull to fracture in several different ways if too much force is used. A doctor can be liable if this causes a skull fracture with complications because of using excessive force with instruments or because he or she should have ordered a Cesarean section after recognizing the delivery would be difficult.
Skull fractures have been known to occur spontaneously during delivery—that is without the use of instruments—but this is rare. It has not been reported very often in the medical literature, and when it has the explanation for why the fracture occurred is not usually well understood. In one reported case an infant had signs of brain damage and a linear fracture was discovered. The baby died at just four years of age. The delivery had been short and without complications.
Spontaneous skull fractures may occur simply because the baby’s head is under tremendous pressure. As it comes out of the womb it is squeezed through past the pelvis, which can press on the head to a large degree, and then it has to pass through the birth canal. Most infants emerge undamaged, but this pressure can, in some cases, lead to fractures.
Linear Skull Fractures
There are a few types of skull fractures that are possible in an infant after childbirth. A linear fracture is a simple break, but one that does not cause the bone to move. One plate will not move past the other or lift up or down. These are not usually too serious, but there may be underlying bleeding.
Depressed Skull Fractures
A depressed skull fracture has the potential to be much more serious. This occurs when the skull is actually sunken inwards. This is more serious than a linear fracture because it is more likely to cause bleeding and to put pressure on the brain. Studies have found that these can be caused by instruments pressing on the head during delivery, but that they sometimes also develop spontaneously. Those caused by instruments are more likely to cause damage to the brain.
Diastatic Skull Fractures
Another type of fracture is diastatic, which means it occurs along a suture. This is fairly common among newborns as compared to children and adults with skull fractures. Because these occur along the sutures, which are supposed to expand as the brain grows, this type of fracture can cause damage as the baby gets older and the fracture expands with the size of the brain.
Minor fractions may not be detected in a newborn. In most cases these are just small, linear fractures, which heal with time and cause no lasting damage. More severe fractures, on the other hand, may cause symptoms. For instance, a depressed fracture may cause a misshapen appearance to the baby’s head or it may appear as a lump. A fracture may also cause damage that leads to seizures, listlessness, bleeding, or bruising.
To assess whether a newborn has suffered a brain fracture a doctor may order imaging scans. These may include X-rays, CT scans, or MRIs. The images can help a doctor see breaks in the bone, bleeding, pressure on the brain, or swelling of the brain. A doctor may also perform simpler examinations before ordering an image, such as neurological and reflex tests.
Treatment for an infant skull fracture depends on the type of fracture, the severity, and any complications it is causing. In most instances, the only treatment is to simply observe and to continue to test the child and image the head. Linear fractures are likely to heal on their own, as are diastatic, although these must be monitored carefully.
A depressed fracture may also simply be monitored, but it may also need to be treated surgically. Fluid or blood, for instance, pooling in the brain can cause lasting damage and may require surgery to remove it. Surgery may also be needed to reduce pressure or swelling.
Prognosis and Complications
Most skull fractures that occur during childbirth are not serious and heal easily. They can be more serious, though, and cause lasting complications. One possible complication is a condition called grow skull fracture. It is rare, but a common cause of it is the misuse of instruments during delivery. This complication is a progressive growing of an existing skull fracture.
As an infant with a skull fracture grows, the enlarging brain puts pressure on the skull and increases the fracture. This can cause seizures and other problems and must be treated surgically.
Skull fractures can also put pressure on the brain or cause bleeding in the brain, potentially serious complications. Bleeding, also known as a hemorrhage can cause brain damage if not treated right away with surgery.
Pressure on the brain can be caused by a hemorrhage, but also be a depressed skull fracture. Even when these potentially damaging complications occur, the prognosis is good for most infants and they will recover.
Overall the prognosis for a child born with a fractured skull is good. Most will not require treatment and most will have no long-term complications. For those few who do have complications, however, these can include brain damage, paralysis, neurological problems, developmental delays, and cognitive impairments.
If your child was born with a fracture and you believe malpractice or negligence played a role, you can make a case with the assistance of a lawyer and seek compensation and justice for your baby.