The Causes and Effects of Neonatal Stroke
What you should know if your child is injured during labor and delivery
Strokes are often associated with individuals of older age in connection with diseases that often affect the elderly population. However, infants can also experience strokes. The possibility of stroke in a newborn infant is actually the same as that in an elderly person. When a neonatal stroke occurs, it can be shocking to the parents. It’s important to understand the causes of neonatal stroke and the signs to watch for in order to prevent this occurrence when possible and also provide proper treatment.
Neonatal stroke defined
Per the National Institutes of Health (NIH), neonatal stroke takes place when the blood supply of the infant is interrupted during the first 28 days after birth. A stroke suffered by an infant in the first seven days after birth is referred to as a perinatal stroke.
The brain experiences oxygen deprivation and blood flow restriction in the blood vessels with both types of strokes. It is estimated that 1 in 4000 babies suffer an arterial ischemic stroke and 1 in 4000 suffer a hemorrhagic neonatal stroke.
Causes of neonatal stroke
Hypoxia is one major cause of neonatal stroke. This occurs when the baby suffers from oxygen deprivation causing a significant negative effect upon the brain. The mother’s health can sometimes determine if her child will suffer a neonatal stroke. Certain disorders of the mother can influence the possibility stroke in the child, including diabetes, infection, coagulation disorders, trauma, autoimmune disorders, prenatal exposure to cocaine, and congenital heart disease.
Factors that can contribute to neonatal strokes in infants prior to birth include chorioamnionitis, infection of the placenta, and placental abruption (when the placenta removes from the inner wall of the uterus).
Other health disorders of the mother and/or the baby that can contribute to the occurrence of neonatal stroke include lipid, homocysteine, and blood disorders, some of which include:
- Lipoprotein(a) deficiency
- Disseminated intravascular coagulopathy
- Prothrombin mutation
- Factor V leiden mutation
- Factor VIII deficiency
A neonatal stroke can develop as a result of infections connected with the central nervous system or other general infections, and cause further birth injury complications. However, sometimes the cause of neonatal stroke is a mystery. Many healthy children have been born through the process of an uncomplicated, normal pregnancy, labor and delivery and still experienced a neonatal stroke.
Ischemic and hemorrhagic strokes
Children can sustain two distinct types of strokes – ischemic and hemorrhagic. Ischemic strokes occur when an obstruction in the brain blocks blood flow. Another name for an ischemic stroke is a “dry stroke” due to the fact that blood flow to the brain is restricted. Hemorrhagic strokes involve bleeding in the brain. Sometimes referred to as “bleeding strokes” or wet strokes, these stroke events cause too much blood inside the brain. Both types of strokes present an emergency situation and can lead to serious permanent injury or even death if they are not diagnosed and treated promptly.
These dry strokes are often the result of a blood clot forming in the heart which then moves to the brain. Congenital heart issues such as infections or abnormal valves can lead to ischemic stroke. Children who suffer this type of stroke may be given antibiotics or require surgery. A blood disorder called sickle cell disease is also often connected with the occurrence of ischemic stroke.
An ischemic stroke can also be caused by trauma that affects large arteries and produces loss of blood flow. For instance, if a child suffers a neck injury, a large artery may be injured that in turn leads to an ischemic stroke.
Certain health issues that a mother may experience during pregnancy can also increase the possibility of her baby having an ischemic stroke – either before or after birth. Some of these conditions include:
- Premature rupture of membranes (water breaking more than 24 hours in advance of labor)
- Problems with the placenta that restricts the supply of oxygen to the baby (i.e. placental abruption)
- Preeclampsia (maternal high blood pressure during pregnancy resulting in swelling of the legs, feet, hands)
- Drug abuse
These wet strokes occur when a blood vessel on or inside the brain breaks, resulting in blood flow into areas of the brain not intended to accept the blood. This can cause pooling of blood in brain tissues, leading to a blood clot. When blood vessels rupture, the blood that is supposed to flow through those vessels never makes it to its intended destination. This condition deprives the brain of oxygen which can result in permanent brain injury. Most often hemorrhagic strokes occur as a result of malformed or weakened arteries (arteriovenous malformations).
Specific illnesses can increase the possibility of a hemorrhagic stroke, such as hemophilia. This disorder involves the blood failing to properly clot. Hemophilia is one of the most common causes of pediatric stroke.
Hemorrhagic strokes can also occur due to an aneurysm (weakened artery wall), arteriovenous malformation (when the blood vessels in the brain fail to properly connect), and head injuries that produce broken blood vessels.
Any failure to diagnose or properly treat a neonatal or pediatric stroke can subject doctors to a medical malpractice or birth injury lawsuit. Doctors must understand, remain aware of, and address the risks of strokes in infants prior to and after birth.
Symptoms of a neonatal stroke
In some cases, no obvious symptoms of neonatal stroke appear. It is extremely difficult to detect a stroke in newborn babies. When no symptoms are blatantly obvious, the baby may have experienced a stroke without any detection for months on end. As the child develops and grows older, certain symptoms of stroke may begin to appear, such as numbness on one side of the body, balance problems, and speech problems.
At other times, neonatal stroke symptoms are more obvious and easier to detect. However, even obvious symptoms such as seizures may be difficult to detect in an infant. Doctors must be able to discern from the baby’s movements or lack thereof whether a stroke has occurred. Certain indications may include jerking movements, pedaling motions with the legs, blank staring, single jerking movements with a limb or the body, and apnea.
Treating neonatal stroke patients
Due to the malleability and flexibility of their brain and nervous system, infants have a high likelihood of recovering from a neonatal stroke. The most important issue from a medical perspective is getting treatment for the stroke immediately when it is diagnosed. From there, the infant’s future healthcare needs can be planned and addressed. Failure of medical personnel to provide this prompt diagnosis and treatment can lead to long-term permanent injuries for the baby.
Infants are commonly provided the following treatments for neonatal stroke:
- Supplying oxygen as needed
- Giving the baby blood thinners
- Hydrating or rehydrating the infant with fluids
- Ordering a blood transfusion if required
- Ordering therapeutic treatments (immediately or long-term) – these may include physical, occupational, and speech therapy
- Treating heart conditions
Diagnosing and treating neonatal stroke in a timely manner can be the key to ensuring the infant patient comes through the event to live a healthy, productive life. Sometimes, however, certain complications can come into play that affect the overall prognosis and well-being of the child. When doctors develop a treatment plan, they must take into account what caused the stroke and how much damage to the brain has occurred.
If your baby suffered a stroke, let us help
Issues that may justify the filing of a medical malpractice or birth injury neonatal stroke claim include any failures of medical personnel to properly prevent the stroke, diagnose the stroke, treat the stroke, or provide post-stroke care. At Crandall & Pera Law, we are here to provide you with intelligent and vigorous representation in the aftermath of your baby’s birth injury. To set up a free, no obligation consultation about your case in Kentucky or Ohio, call us today at 877.955.0020 or complete our contact form.