Extremely Preterm Brain Injury Claims NY

When a baby is born extremely prematurely, their developing brain faces heightened vulnerability to serious injuries that can affect them for life. Extremely preterm brain injury refers to damage sustained by infants born before 28 weeks of gestation, a critical period when the brain’s structures are still forming and particularly susceptible to harm. These injuries can result from medical complications, inadequate prenatal care, or errors during delivery, and families affected by preventable brain injuries may have grounds for a medical malpractice claim to secure compensation for lifelong care needs.

What Is Extremely Preterm Birth?

Extremely preterm birth occurs when an infant is delivered before 28 weeks of gestation. According to the CDC, preterm birth affects approximately 10.41% of all births in the United States, with extremely preterm births representing the highest-risk category. While all premature babies face health challenges, extremely preterm infants encounter far more serious complications due to the immature state of their organ systems, particularly the brain.

At this early stage of development, the brain lacks the protective mechanisms and structural integrity that develop in later weeks of pregnancy. The blood vessels are fragile, the white matter structures are vulnerable, and the systems that regulate blood flow and oxygen delivery are not yet fully functional. Research published in Cells indicates that approximately 15 million preterm births occur worldwide annually, creating a significant global health burden.

Categories of Preterm Birth

Medical professionals classify premature births into several categories based on gestational age:

• Extremely preterm: Born before 28 weeks of gestation
• Very preterm: Born between 28 and 32 weeks of gestation
• Moderate to late preterm: Born between 32 and 37 weeks of gestation

The earlier a baby is born, the greater the risk of complications. Extremely preterm infants require intensive medical care in a neonatal intensive care unit (NICU) and face substantially higher rates of brain injury compared to babies born even just a few weeks later.

How Common Is Brain Injury in Extremely Preterm Infants?

Brain injury is alarmingly common among extremely preterm infants. A comprehensive study published in European Radiology examined 507 preterm infants and found that 48.3% of all preterm infants showed evidence of brain injury on MRI scans performed at term-equivalent age. However, the incidence was dramatically higher among extremely preterm babies specifically.

The same study revealed that specific types of brain injury were far more prevalent in the extremely preterm population:

These statistics underscore the extraordinary vulnerability of extremely preterm infants and highlight why proper medical care during pregnancy, delivery, and the neonatal period is absolutely critical.

Types of Brain Injury in Extremely Preterm Infants

Several distinct types of brain injury can affect extremely preterm infants, each with its own characteristics, causes, and potential consequences. Understanding these different injury patterns is essential for recognizing when medical negligence may have played a role.

Intraventricular Hemorrhage (IVH)

Intraventricular hemorrhage involves bleeding into the brain’s ventricular system, the fluid-filled spaces within the brain. This condition occurs in approximately 31.9% of extremely preterm infants. The bleeding originates in the germinal matrix, a fragile network of blood vessels near the ventricles that is particularly vulnerable during the period from 24 to 32 weeks of gestation.

IVH is graded on a scale from I to IV based on severity:

• Grade I and II: Bleeding is confined to the germinal matrix or extends into the ventricles without enlargement
• Grade III: Bleeding causes ventricular enlargement
• Grade IV: Bleeding extends into the brain tissue itself (periventricular hemorrhagic infarction)

Higher-grade hemorrhages significantly increase the risk of long-term neurological impairment, including cerebral palsy, developmental delays, and cognitive deficits.

Periventricular Leukomalacia (PVL)

Periventricular leukomalacia represents damage to the white matter surrounding the brain’s ventricles. According to research in The Lancet Neurology, PVL affects 50% or more of very low birth weight infants. The condition involves both focal areas of tissue death and more diffuse injury to developing brain cells called oligodendrocytes.

White matter contains the neural pathways that connect different brain regions, and damage to these structures can severely impact motor function, particularly affecting the legs more than the arms. This pattern of injury explains why PVL is strongly associated with spastic diplegia, a form of cerebral palsy characterized by stiffness and difficulty with movement primarily in the lower extremities.

Cerebellar Hemorrhage

The cerebellum, located at the back of the brain, plays crucial roles in motor coordination, balance, and increasingly recognized cognitive functions. Cerebellar hemorrhage affects 18.0% of extremely preterm infants and can have profound long-term consequences. Research has shown that cerebellar involvement particularly correlates with cognitive outcomes, meaning that damage to this structure may impact not only physical coordination but also learning and intellectual development.

Diffuse White Matter Injury

Beyond the focal injuries described above, many extremely preterm infants experience diffuse white matter injury. This more widespread pattern of damage affects the developing white matter throughout the brain and is linked to inflammation, oxygen deprivation, and disrupted brain development. The study in Cells explains that diffuse white matter injury has become the predominant form of brain injury in modern neonatal care.

What Causes Brain Injury in Extremely Preterm Infants?

The causes of brain injury in extremely preterm infants are complex and often involve multiple contributing factors. Understanding these causes is essential for determining whether medical negligence played a role in a child’s injury.

Prematurity Itself as a Risk Factor

The extreme immaturity of the brain is the fundamental risk factor. At 24 to 27 weeks of gestation, critical brain structures are still developing. Blood vessels are fragile and prone to rupture, white matter cells are vulnerable to injury, and the mechanisms that normally protect the brain from inflammation and oxygen fluctuations are not yet mature.

Inflammation and Infection

Maternal and fetal infections play a major role in preterm brain injury. Research published in Cells found that 11-40% of preterm births are linked to chorioamnionitis (infection of the membranes surrounding the fetus), and at the earliest gestational ages, 94% of placentas show evidence of chorioamnionitis.

When infection occurs, inflammatory chemicals are released that can directly damage developing brain cells and make the brain more vulnerable to other insults like oxygen deprivation. This inflammatory cascade can continue even after birth, perpetuating brain injury in the neonatal period.

Hypoxia-Ischemia (Oxygen Deprivation)

Inadequate oxygen delivery to the brain, whether due to problems with the placenta, umbilical cord complications, respiratory distress after birth, or cardiovascular instability, can cause significant brain damage. According to Cells, moderate-to-severe hypoxic-ischemic encephalopathy occurs in 37.3 per 1,000 preterm births.

The developing white matter is particularly sensitive to oxygen deprivation. Even brief periods of reduced oxygen or blood flow can trigger cell death and disrupt normal brain development.

Blood Pressure Instability

Extremely preterm infants have immature cardiovascular systems and struggle to maintain stable blood pressure. Fluctuations in blood pressure can cause blood vessels in the fragile germinal matrix to rupture, leading to intraventricular hemorrhage. Additionally, periods of low blood pressure reduce oxygen delivery to vulnerable brain regions.

Respiratory Complications

Premature lungs are often underdeveloped, and many extremely preterm infants require mechanical ventilation. While life-saving, ventilation can contribute to brain injury through several mechanisms: oxygen level fluctuations, blood pressure changes, and inflammation triggered by lung injury.

Signs and Symptoms of Brain Injury in Preterm Infants

Recognizing brain injury in extremely preterm infants requires careful monitoring and specialized imaging. Unlike older children or adults who can report symptoms, premature newborns cannot communicate discomfort or neurological problems, making medical surveillance critical.

Acute Signs in the NICU

During the initial hospitalization, several warning signs may indicate brain injury:

• Seizures: Abnormal electrical activity in the brain may cause rhythmic movements, staring spells, or changes in vital signs
• Abnormal muscle tone: Excessive stiffness or unusual floppiness
• Feeding difficulties: Problems with sucking, swallowing, or coordinating breathing with feeding
• Apnea and bradycardia: Frequent pauses in breathing and drops in heart rate
• Lethargy: Decreased responsiveness or alertness

Imaging Findings

The most definitive way to identify brain injury in extremely preterm infants is through neuroimaging:

• Cranial ultrasound: Performed routinely at bedside in the NICU to screen for IVH and other major abnormalities
• MRI: Provides detailed images of brain structure and is typically performed around term-equivalent age to assess for white matter injury, cerebellar damage, and other lesions

According to the European Radiology study, cerebral MRI at term-equivalent age is the gold standard for detecting the full spectrum of brain injuries in preterm infants.

Developmental Red Flags

As children grow, certain developmental delays may signal earlier brain injury:

• Motor delays: Not rolling, sitting, crawling, or walking at expected ages (adjusted for prematurity)
• Muscle abnormalities: Persistent stiffness, weakness, or asymmetry
• Cognitive delays: Slow language development, difficulty with problem-solving, or learning challenges
• Vision or hearing problems: These can occur independently or alongside brain injury

The Emory School of Medicine notes that most preterm infants should be assessed using corrected age (adjusted for their prematurity) rather than chronological age when evaluating development.

Long-Term Effects and Outcomes

The long-term consequences of extremely preterm brain injury vary widely depending on the type, severity, and location of the damage. Some children experience minimal impairment, while others face significant lifelong challenges.

Cerebral Palsy

Cerebral palsy represents one of the most significant potential outcomes of preterm brain injury. According to data from the NIH, the risk of cerebral palsy increases dramatically with earlier delivery. The birth prevalence of cerebral palsy can reach up to 15% among preterm infants born between 24 and 27 weeks of gestation.

For extremely preterm infants specifically, the absolute risk is approximately 8.5% at 23-27 weeks gestation. This represents a rate that is 70 times higher than in term infants. Additionally, research shows that from 2008 to 2019, the odds of cerebral palsy among surviving preterm infants born before 27 weeks increased by an average of 11% per year.

Cognitive and Learning Disabilities

Research in The Lancet Neurology indicates that cognitive deficits occur in 25-50% of infants with periventricular leukomalacia. These challenges may include:

• Lower IQ scores compared to term-born peers
• Difficulties with executive function (planning, organization, impulse control)
• Learning disabilities affecting reading, math, or writing
• Attention deficit disorders
• Memory problems

Motor Impairments

Even children who do not receive a cerebral palsy diagnosis may experience motor difficulties:

• Delays in reaching motor milestones
• Fine motor challenges affecting handwriting and self-care skills
• Coordination problems impacting sports and physical activities
• Muscle weakness or abnormal muscle tone

The Emory School of Medicine explains that 10% of infants weighing under 1,000 grams at birth eventually receive a cerebral palsy diagnosis, and many others experience less severe but still significant motor impairments.

Sensory Impairments

Brain injury in extremely preterm infants can affect vision and hearing. Some children develop:

• Cortical visual impairment (vision problems caused by brain damage rather than eye problems)
• Hearing loss or auditory processing difficulties
• Sensitivity to sensory input

Behavioral and Social Challenges

Children who experienced preterm brain injury may face:

• Autism spectrum disorders (higher rates in preterm populations)
• Anxiety and emotional regulation difficulties
• Social skills challenges
• Behavioral problems

When Does Brain Injury Constitute Medical Malpractice?

Not all brain injuries in extremely preterm infants result from medical negligence. However, when healthcare providers fail to meet accepted standards of care, and that failure leads to preventable injury, families may have grounds for a medical malpractice claim.

Failure to Prevent Premature Birth

Medical negligence that leads to extremely preterm birth can include:

• Failure to diagnose or treat preterm labor: Missing signs of preterm labor or failing to administer appropriate interventions like tocolytics to delay delivery
• Inadequate management of pregnancy complications: Failing to properly manage conditions like preeclampsia, gestational diabetes, or intrauterine infection
• Failure to identify and treat infections: Missing maternal infections that trigger preterm labor
• Inappropriate interventions: Unnecessarily inducing labor or performing a cesarean section too early without proper medical justification

Negligent Delivery and Immediate Neonatal Care

Errors during and immediately after delivery can cause or worsen brain injury:

• Failure to have appropriate personnel present: Extremely preterm deliveries require neonatologists and specialized equipment; failing to have these available represents negligence
• Improper resuscitation: Errors in stabilizing the infant, managing oxygen levels, or supporting breathing
• Delayed recognition of complications: Failing to quickly identify and treat respiratory distress, cardiovascular instability, or other critical problems

Inadequate NICU Care

During the weeks or months in the NICU, several forms of negligence can lead to brain injury:

• Failure to monitor: Inadequate monitoring of vital signs, oxygen levels, or neurological status
• Medication errors: Administering incorrect doses of medications or failing to give necessary treatments
• Improper ventilator management: Settings that cause oxygen level fluctuations or lung injury
• Delayed treatment of complications: Failing to promptly address infections, bleeding, or other emergencies
• Failure to perform appropriate screening: Not conducting indicated ultrasounds or other imaging to detect brain injury early

A Recent Case Example

A lawsuit reported by the Connecticut Post illustrates how NICU errors can cause catastrophic brain damage. Parents alleged that their daughter suffered permanent brain injury when a nurse administered approximately 200 mL of intravenous fluid over two hours—25 times the prescribed amount. The infant subsequently developed severe deficits in motor skills, cognitive ability, speech, and language skills, and remains at risk for seizures.

Compensation Available in Birth Injury Cases

When medical malpractice causes or contributes to extremely preterm brain injury, families can seek compensation for both economic and non-economic damages.

Economic Damages

These cover the financial costs associated with the injury:

• Past and future medical expenses: Surgeries, hospitalizations, medications, medical equipment, and ongoing treatment
• Therapy costs: Physical therapy, occupational therapy, speech therapy, and other therapeutic interventions the child will need throughout life
• Special education services: Costs of specialized schooling, tutoring, and educational support
• Home modifications: Wheelchair ramps, bathroom modifications, and other adaptations to accommodate disabilities
• Assistive devices: Wheelchairs, communication devices, orthotics, and other necessary equipment
• Lost parental income: Compensation for time parents must take off work to care for their child
• Future care needs: Lifetime care costs, which can be substantial for children with severe disabilities

Non-Economic Damages

These compensate for intangible losses:

• Pain and suffering: The child’s physical pain and emotional distress
• Loss of quality of life: Compensation for the child’s diminished ability to enjoy activities and experiences
• Loss of future earning capacity: If the child’s disabilities will prevent them from working or limit their career options
• Emotional distress: In some cases, parents may recover for their own emotional trauma

Settlement and Verdict Amounts

According to Lawsuit Information Center, birth injury malpractice lawsuits have the highest potential settlement or verdict value of any personal injury case, with median and average verdicts approximately 30% higher than other medical malpractice claims.

Recent settlements and verdicts in birth injury cases include:

It is important to understand that every case is unique, and settlement values depend on the severity of injury, the strength of evidence of negligence, the child’s prognosis, and many other factors.

How a Birth Injury Lawyer Can Help

Pursuing a medical malpractice claim for extremely preterm brain injury requires specialized legal and medical expertise. An experienced birth injury lawyer provides essential support throughout this complex process.

Case Investigation and Expert Review

A lawyer will:

• Obtain and thoroughly review all medical records from pregnancy, delivery, and neonatal care
• Retain qualified medical experts to review the case and determine whether the standard of care was breached
• Identify exactly when and how negligence occurred
• Establish the causal connection between the negligence and the child’s injuries

Calculating Full Damages

An attorney works with medical professionals, life care planners, economists, and other experts to calculate the complete scope of your child’s needs and losses, including:

• Comprehensive life care planning to project lifetime medical and therapeutic needs
• Economic analysis of lost earning capacity
• Assessment of necessary home modifications and equipment
• Calculation of the full financial impact on your family

Managing the Legal Process

Birth injury cases involve complex procedures and strict deadlines. A lawyer handles:

• Statute of limitations compliance: Each state has specific deadlines for filing medical malpractice claims; missing these deadlines means losing your right to compensation
• Filing requirements: Medical malpractice cases often require certificates of merit or expert affidavits to be filed with the initial complaint
• Discovery: The process of exchanging information and evidence with the defense
• Expert testimony: Coordinating medical experts who will testify about the standard of care and causation
• Negotiations: Skillfully negotiating with insurance companies and defense attorneys to achieve the best possible settlement
• Trial: If a fair settlement cannot be reached, presenting your case effectively to a jury

Advocating for Fair Compensation

Insurance companies and healthcare institutions often have teams of lawyers working to minimize their liability. Having an experienced advocate on your side levels the playing field and ensures your child’s interests are protected. Your attorney will fight to secure compensation that truly reflects the lifetime needs of a child with extremely preterm brain injury.

Time Limits for Filing a Claim in New York

New York has specific statutes of limitations for medical malpractice cases involving birth injuries. Generally, a medical malpractice action must be commenced within two and a half years from the date of the alleged malpractice. However, special rules apply to birth injury cases involving minors.

For infants, the statute of limitations may be tolled (delayed) until the child’s 10th birthday, meaning families have until the child turns 10 to file a lawsuit. However, there are exceptions and complexities to this rule, and waiting too long can jeopardize your case because:

• Medical records may be destroyed
• Witnesses’ memories fade
• Key evidence may be lost
• Healthcare providers may retire or relocate

Steps to Take if You Suspect Medical Negligence

If you believe medical errors contributed to your child’s extremely preterm birth or brain injury, take these important steps:

1. Obtain Complete Medical Records

Request copies of all medical records, including:

• Prenatal care records
• Labor and delivery records
• All NICU records
• Imaging studies (ultrasounds, MRIs)
• Physician notes and nursing notes

2. Document Your Child’s Condition

Keep detailed records of:

• All diagnoses
• Treatments and therapies
• Medical appointments
• Developmental assessments
• Expenses related to your child’s care

3. Preserve Evidence

Save:

• Communications with healthcare providers
• Hospital bills and insurance statements
• Photos or videos documenting your child’s condition
• Notes about conversations with medical staff

4. Consult a Birth Injury Attorney

Schedule a consultation with an experienced attorney who can:

• Evaluate whether you have a viable case
• Explain your legal options
• Begin the investigation process
• Protect your rights and meet all deadlines

5. Continue Your Child’s Medical Care

Maintain all recommended medical appointments and therapies. Gaps in treatment can be used by the defense to argue that the child’s condition is not as serious as claimed or that the parents are not mitigating damages.

Frequently Asked Questions

Get Legal Help for Your Child’s Birth Injury

If your child suffered brain injury as an extremely preterm infant, and you believe medical negligence played a role, you deserve answers and your child deserves compensation for their lifelong needs. Birth injury cases are complex, but with the right legal representation, you can hold responsible parties accountable and secure the resources necessary to provide your child with the best possible care and quality of life.

Every case is unique, and the first step is understanding whether you have a valid claim. A thorough investigation of the medical records and consultation with qualified experts can reveal whether healthcare providers met the appropriate standard of care or whether negligence occurred.