When a baby struggles during or after birth, medical staff need to quickly determine whether brain injury has occurred and how severe it might be. Unlike broken bones or visible injuries, brain damage isn’t something you can see just by looking at a newborn. That’s where medical testing becomes crucial.

These tests serve multiple purposes. They help doctors understand what treatment the baby needs immediately, give parents information about likely outcomes, and later can reveal whether the injury was preventable or resulted from inadequate care during birth.

The Apgar Score: The First Assessment

Before any specialized testing happens, every newborn receives an Apgar score at one minute and five minutes after birth. This quick assessment looks at five things: heart rate, breathing, muscle tone, reflexes, and color. Each gets scored 0, 1, or 2, with 10 being the highest possible total.

A baby with a low Apgar score—particularly if it stays low at five minutes—needs immediate help and raises concerns about possible oxygen deprivation. While a low Apgar alone doesn’t confirm brain injury, it’s often the first sign that something went wrong and signals the need for further testing.

Blood Gas Analysis Tells the Oxygen Story

One of the first tests after a difficult birth is blood gas analysis, usually taken from the umbilical cord. This measures pH levels and shows how acidotic (lacking oxygen) the baby became during birth.

The pH number matters because it indicates how long and how severely oxygen was compromised. A very low pH (high acidity) suggests prolonged oxygen deprivation, which increases brain injury risk. Normal cord pH is around 7.25 or higher. When it drops below 7.0, concern increases significantly.

Doctors also look at something called base deficit, which gives additional information about how the baby’s body responded to oxygen shortage. These numbers, combined with the baby’s condition at birth, help determine the severity of what happened.

MRI Scans Show Brain Damage Details

Magnetic resonance imaging (MRI) is the gold standard for detecting brain injury in newborns. Unlike other scans, MRI shows detailed images of brain tissue and can reveal areas of damage that other tests might miss.

The timing of MRI matters. Scans done too early might not show the full extent of injury because damage can take days to appear clearly on imaging. Many specialists recommend MRI around day 4-7 after birth for the most accurate picture of injury.

MRI results show which parts of the brain were affected and how extensively. Deep brain structures being damaged (basal ganglia and thalamus) versus outer brain areas (cortex) affects what disabilities might develop. The scan can also show whether damage is on one side or both, which impacts the type of cerebral palsy that might result.

For families dealing with birth brain injury, understanding what MRI results reveal helps when pursuing a Brain Injury At Birth Claim, as these scans provide objective evidence of the injury’s timing and severity.

Cranial Ultrasound: The Bedside Option

While babies are in the neonatal unit, they often get cranial ultrasounds. These can be done right at the bedside without moving the baby, which is why they’re used frequently in those early days.

Ultrasound uses sound waves to create images of the brain through the soft spot (fontanelle) in a baby’s skull. It’s good at detecting bleeding in the brain, fluid accumulation, and some types of damage, though it doesn’t show as much detail as MRI.

The advantage of ultrasound is that it can be repeated easily to monitor changes. If bleeding or swelling is present, serial ultrasounds track whether it’s getting better, worse, or staying stable.

EEG Monitors Brain Activity

An electroencephalogram (EEG) measures electrical activity in the brain. For babies who’ve experienced oxygen deprivation, abnormal EEG patterns can indicate seizures or show that brain function is significantly compromised.

Some babies get continuous EEG monitoring (called amplitude-integrated EEG or aEEG) for days after birth. This ongoing monitoring catches seizure activity that might not be visible on the outside—newborn seizures often don’t look like the convulsions people expect.

The EEG background pattern also gives information about prognosis. Very abnormal, flat patterns suggest more severe injury than mildly abnormal patterns. As babies recover, improvement in EEG readings is an encouraging sign.

Cooling Treatment and Associated Monitoring

When moderate to severe oxygen deprivation is suspected, babies might receive therapeutic hypothermia—being cooled to about 33.5°C for 72 hours. This treatment reduces brain injury but requires intensive monitoring.

During cooling, babies receive frequent blood tests, continuous heart monitoring, and regular neurological assessments. The monitoring data collected during this treatment period becomes part of the medical record that later helps determine whether appropriate care was provided.

What Test Results Mean for Parents

Getting test results when your baby is in intensive care feels overwhelming. Medical staff might use terms like “HIE grade 2” or talk about “abnormal signals in the basal ganglia,” and none of it makes immediate sense to parents in crisis.

It’s worth asking for explanations in plain language. What does this finding mean for our baby? What are we looking for as signs of improvement or concern? What do these results tell us about the future?

Test results early on don’t always predict outcomes perfectly. Some babies with concerning early scans do better than expected, while others with initially mild findings develop more problems. The brain’s ability to compensate and heal, particularly in newborns, makes definite predictions difficult.

When Tests Reveal Preventable Injury

Sometimes test results show patterns that raise questions about whether the injury could have been prevented. For example, if MRI shows damage consistent with prolonged oxygen deprivation, but birth records show abnormal fetal heart traces were present for hours before delivery, that gap between warning and action becomes significant.

Test results showing severe acute injury from birth don’t mean negligence automatically occurred. But when combined with birth records showing missed warning signs or delayed response to obvious fetal distress, these tests become evidence that supports concerns about inadequate care.

The Follow-Up Testing That Comes Later

Brain injury assessment doesn’t end when babies leave the hospital. Follow-up imaging often happens at several months old to see how the brain has developed and which areas show permanent damage.

Developmental assessments track whether the baby is meeting milestones or showing delays in movement, cognition, or other areas. These ongoing evaluations help determine what therapies and support the child needs and provide a fuller picture of how the birth injury impacts their life.

Understanding What Tests Can and Can’t Tell Us

Medical testing after difficult births serves essential purposes—guiding immediate treatment, helping predict outcomes, and documenting what occurred. But tests have limitations. They can’t always distinguish between damage that occurred during pregnancy versus during birth. They can’t predict with certainty which babies will develop disabilities.

What tests can do is provide objective information about whether brain injury occurred, its severity, and its likely cause. When that information suggests preventable harm from inadequate response to birth complications, families deserve answers about whether better care could have changed their baby’s outcome.