Cerebral palsy is one of the most serious conditions we encounter in our medical negligence practice.
In many of the cases Cian O’Carroll Solicitors have investigated, the diagnosis of cerebral palsy follows a difficult labour, a traumatic delivery or a challenging period of neo-natal care in the hours, days or weeks after birth. For families, the question that arises is an obvious one:
Was this devastating brain injury to their baby avoidable?
We have acted in some of the most complex and hard-fought cerebral palsy cases to come before the High Court of Ireland and achieved landmark outcomes that provide and will go on providing necessary care and supports for those individuals and families that we were honoured to represent.
When does Cerebral Palsy occur?
Cerebral palsy is caused by injury to a baby’s developing brain. That injury can occur:
Understanding when the injury occurred is often the key issue in these cases.
MRI scans, together with the clinical history, can usually identify the pattern (and thereby the timing) of injury. This information often allows our expert witnesses to distinguish between injury that was unavoidable and injury that may be linked to a failure in care.
Injury in pre-term babies
In premature babies, brain injury can arise because of the fragility of the developing brain.
One example is periventricular leukomalacia (PVL), a condition affecting the brain’s white matter. These cases are most often associated with prematurity itself rather than negligent care. However, that is not always the case, and in our work we have identified instances where PVL was linked to failures in care.
In those cases, the injury has typically – but not only – arisen in one of two ways. The first is poor management of a pre-term delivery, leading to a critical lack of oxygen. The second is physical trauma during delivery, for example through the inappropriate use of instruments such as vacuum or forceps. In some cases, this trauma has caused bleeding within the deep structures of the brain, which in turn has led to PVL and ultimately cerebral palsy.
We have also seen how failures in the management and preparation for an unexpected pre-term delivery can result in brain injury. Pre-term babies often have underdeveloped lungs and are therefore particularly vulnerable to respiratory distress, which can lead to oxygen deprivation and brain damage.
For that reason, obstetric teams anticipate pre-term delivery by administering specific medications to the mother. These typically include:
These treatments are particularly important in pregnancies below 32 weeks’ gestation. A failure to administer them, where indicated, may amount to negligent care.
In addition, issues such as infection, the management of seizures, and broader failings in neonatal care can all contribute to periods of oxygen deprivation or direct injury to the immature brain.
In many cases, these issues can be identified through careful review of the medical records, including neonatal observations, blood results, imaging and the documented clinical condition of the baby in those early hours and days.
Each case requires careful analysis of both the timing and mechanism of injury, while recognising that pre-term delivery—particularly extreme prematurity (before 28 weeks’ gestation)—carries an inherent risk of brain injury, even where care is of a very high standard.
Our role is to distinguish between those unavoidable risks and cases where a failure in care has made a material difference to the outcome.
Injury at or near full term
In full-term babies, the issues are usually different, as the baby is more mature and better adapted to life outside the womb.
The most common pattern we see involves injury caused by a lack of oxygen during labour or delivery, known as hypoxic ischaemic injury. In more serious cases, this presents as hypoxic ischaemic encephalopathy (HIE).
HIE is diagnosed based on a combination of clinical signs and investigation. These may include poor muscle tone, seizure activity, difficulty feeding, reduced alertness and low Apgar scores. In addition, analysis of umbilical cord blood gases is often a critical piece of evidence, indicating whether the baby experienced significant oxygen deprivation at or around the time of birth.
The obstetric questions we investigate in these cases include:
These are complex clinical issues requiring detailed review of the medical records and input from independent experts in obstetrics, neuroradiology and neonatology among others.
MRI imaging is particularly important, as it can demonstrate a pattern of injury consistent with oxygen deprivation during labour.
In many of the cases we have investigated, there are clear indicators within the records—such as abnormal CTG traces, delayed intervention or compromised blood gas results—that point to an injury occurring in this critical period. The injury itself is typically clear, the issue is linking it back to a failure in care.
Injury in the neonatal period
Brain injury can also occur after birth, in the first hours or days of life.
At Cian O’Carroll Solicitors, we have investigated cases where injury followed failures to recognise or treat:
In these situations, the issue is often one of timing; whether emerging clinical signs were recognised and acted upon quickly enough to prevent brain injury.
Newborn babies who have suffered a difficult delivery, or who are otherwise vulnerable, require close and careful monitoring in this early period. A deterioration in their condition may be reflected in feeding difficulties, abnormal tone (either unusually floppy or rigid), jitteriness, seizures, abnormal blood results, or increasing respiratory support requirements.
We have also seen cases where hypoglycaemia was either not identified or not treated aggressively enough, and cases where rising bilirubin levels leading to jaundice were not managed in time. Both conditions are well recognised causes of preventable brain injury if not properly addressed.
In many of the cases we have investigated, the medical records show a developing clinical picture over a number of hours, sometimes longer, and the question becomes whether appropriate intervention at an earlier stage would have prevented the injury.
How we investigate cerebral palsy cases
These cases require a careful and methodical approach.
We begin by reviewing all relevant medical records, including:
If concerns arise, we then work with independent experts in obstetrics, neonatology, neurology and neuroradiology to assess whether the care provided met an acceptable standard.
The next step is to address causation. Even where a failure is identified, it must be shown that this caused the injury; that the injury would not have arisen anyway due to some existing health issue.
That analysis is often complex and depends on a combination of clinical findings, imaging, and expert opinion.
What legal action can achieve
Where negligence can be established, a legal case serves two important purposes.
First, it provides answers and accountability for what has happened.
Second, it allows for a full assessment of the child’s future needs. In cerebral palsy cases, that may include:
These cases are ultimately about ensuring that a child and their family have the resources they need to maximise that person’s ability in life.
A careful and realistic approach
Not all cases of cerebral palsy are caused by negligent care; in fact most are not.
However, where there has been a difficult birth or you have concerns about early neonatal care, it is entirely appropriate to ask questions.
Our role is to investigate those questions carefully, obtain independent expert opinion, and provide clear answers and legal advice.
If a case in negligence is established, Cian O’Carroll Solicitors pursue it fully to ensure that your child’s needs are identified, documented and provided for.
Learn more about our cases and how we have worked with our clients to achieve life changing results in terms of damages, provision of care and accountability.
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