Neonatal Stroke Birth Injuries

While strokes are usually associated with the elderly, there is also a risk of strokes before, during, and shortly after childbirth. Children who suffer from a neonatal stroke may have permanent cognitive as a result of their stroke.

The signs and symptoms are not easily detectable before childbirth. This means that many infants who experienced a stroke may go untreated. This would result in further complications such as brain damage, cerebral palsy, difficulty learning, and other disabilities.

What Is a Neonatal Stroke?

A neonatal stroke occurs when blood flow to an infant’s brain is interrupted or blocked within the first 28 days after birth. If the stroke occurred within the first seven days, it is referred to as a perinatal stroke. During a neonatal stroke, the brain experiences oxygen deprivation and blockage to the blood vessels. The neonatal stroke occurrence rate is about 1 in 4,000 babies. However, the actual occurrence rate may be higher because of how difficult it is to detect a neonatal stroke.

What Are the Causes and Factors of a Neonatal Stroke?

There are several different causes and factors that can lead to a neonatal stroke. One cause is hypoxia, which occurs when a baby is deprived of oxygen. This can cause the brain to experience irregular activity. The mother’s overall health can also affect whether or not her child might experience a stroke. If she has a history of conditions such as autoimmune disorders, coagulation disorders, congenital heart disease, diabetes, and trauma, her child would be at a higher risk of developing a neonatal stroke.

Mothers who have been using cocaine during their pregnancies will put their child at risk as well. Maternal infections that affect the central nervous system or other systemic infections can cause a neonatal stroke.

While these conditions may indicate a neonatal stroke, healthy children born in good conditions such as normal labor and delivery may experience a neonatal stroke as well. This reinforces how difficult it is to figure out whether or not a baby experienced a neonatal stroke.

Neonatal Stroke Symptoms

Unfortunately, an infant may not show outward signs that they are experiencing a neonatal stroke. They may even go several months without anyone detecting something suspicious. The symptoms would only become noticeable as the child would get older. These symptoms include difficulties with speech, difficulty with balance, and numbness on a side of their body.

When a child shows an outward symptom of a neonatal stroke, it is usually a seizure. However, seizure symptoms can be difficult to detect in newborns. These symptoms include facial movements such as sucking, chewing, or eye movement. Movements that resemble bicycling or pedaling can also be seen as well. Staring is also another symptom as well. Another symptom is when a child

How Is Neonatal Stroke Diagnosed?

A neonatal stroke can sometimes be detected while the baby is in the womb. This occurs when there may be a possibility of a birth defect. When this happens, the mother would then be given a fetal MRI, which is effective in detecting whether or the fetus had a stroke. Sometimes, the stroke might be severe enough that it could be detected through an ultrasound. Upon birth, further imaging must be performed on the child to confirm the diagnosis

Any newborn having a seizure should have their head examined via ultrasound and CT scans. MRI should also be administered as well.

How Can Neonatal Strokes be Treated?

The specific interventions for a neonatal stroke depend on the particular aspect of cognitive function that was impacted by the stroke. Ultimately, it is not the specific diagnosis that is critical for the treatment of a neonatal stroke because the type of interventions that can help children are largely going to be the same as they would be for the same cognitive problem without a history of stroke.

In terms of immediate treatment for the injury, there are two ways to treat neonatal stroke. The first is therapeutic hypothermia, which administered brain cooling. The second is hyperbaric oxygen therapy.

One such way that neonatal strokes can be treated is through therapeutic hypothermia, which would be locally administered on the head. This specific administration is informally known as “brain cooling.” Lowering the brain’s temperature can slow brain activity down, as to prevent any further damage to it. It can prevent the brain from overheating as a result of increased blood flow. In addition, constricting blood vessels reduces the likelihood of less brain damage.

Hyperbaric oxygen therapy works by putting an infant in a pressurized room that consists of 100% oxygen. The pressurization allows for one to inhale more oxygen than if they were to breathe pure oxygen at regular air pressure conditions. This allows the infant to breathe nothing but oxygen, which can help make up for lost oxygen.

As therapeutic hypothermia and hyperbaric oxygen therapy are both relatively novel, some doctors may shy away from it. The two conventional methods of treatment are urokinase and heparin. Urokinase is an agent that comes from human neonatal kidney cells. It is administered via injection and can help treat bleeding. Heparin is an anticoagulant that helps reduce blood clotting and prevents the formation of harmful ones in blood vessels.

• Getting ahead of the game: prophylactic use of erythropoietin for neonatal stroke

What Should I Do If I Think my Baby had a Neonatal Stroke?

What you should do is make sure your child gets medical attention as soon as possible. The sooner your child attention, the less likely they will experience even further health complications. If you suspect any remote possibility that your child has had a stroke, always contact a medical professional.

How Can I Prevent my Baby From Having a Stroke?

Preventing your baby from having a stroke starts with you. Many neonatal strokes occur in pregnancy, making it very important that you take care of your own health. This helps your child receive healthy blood flow while they are still in the womb. Eat properly, refrain from smoking, and stay hydrated.

If you or your family have a history of clot-related disorders, you should be tested to see if you carry a genetic disorder known as Factor V Leiden, which may cause clotting in your baby. If doctors know that the baby might have Factor V Leiden, they can take steps to manage it.

A partial blood transfusion exchange, with blood diluted in saline, may help prevent a stroke. This can help if the baby’s red blood cells count is high due to pregnancy or childbirth complications. A high red blood cell count may also cause blood clots as well.

Medical Literature

Pretzel, P., et al. (2022). Structural Brain Connectivity in children after Neonatal Stroke: A Whole-brain Fixel-based Analysis. NeuroImage: Clinical, 34, 103035.

This study looked at how a fixel-based analysis characterized a neonatal stroke’s long-term effects on white matter outside of the lesion.

Larpthaveesarp, A., et al. (2021). Enhanced mesenchymal stromal cells or erythropoietin provide long-term functional benefit after neonatal stroke. Stroke, 52(1), 284-293.

This study found that single dose mesenchymal stromal cells or multi-dose erythropoietin improved long-term neurobehavioral outcomes, even with administration delays, in children who suffered neonatal strokes. The researchers found that erythropoietin was the most effective.

Steggerda, S.J., & de Vries, L.S. (2021). Neonatal stroke in premature neonates. Seminars in Perinatology, 45(7), 151471.

This article reported on recent literature on neonatal strokes in premature neonates. The researchers focused on neuro-imaging findings.

Chen, H. R., et al. (2020). Fate mapping via CCR2-CreER mice reveals monocyte-to-microglia transition in development and neonatal stroke. Science advances, 6(35), eabb2119.

This article looked at a fate mapping strategy that showed that monocytes transformed into a morphology that expressed microglial marker genes following a neonatal stroke.

Peterson, R.K., et al. (2020). Parent experiences and developmental outcomes following neonatal stroke. The Clinical Neuropsychologist, 35(5), 973-987.

This article looked at a neuropsychologist’s role in neonatal stroke care, educating families, and monitoring outcomes. It also emphasized the importance of mental health support for parents of children with a neonatal stroke history and reiterated the importance of environmental factors impacting a child’s functioning.

Kirton, A., et al. (2009). Advances in perinatal ischemic stroke. Pediatric neurology, 40(3), 205-214.

This review looked at recent advancements, current understanding, and future research directions in perinatal ischemic strokes.

Rafay, M.F., et al. (2009). Predictive value of clinical and EEG features in the diagnosis of stroke and hypoxic ischemic encephalopathy in neonates with seizures. Stroke, 40(7), 2402-2407.

This study attempted to differentiate between neonatal strokes and hypoxic-ischemic encephalopathy. The researchers found that onset seizures occurring 12 hours after birth and clinically observed focal seizures were stroke predictors.

Westmacott, R., et al. (2009). Late emergence of cognitive deficits after unilateral neonatal stroke. Stroke, 40(6), 2012-2019.

This study looked at neonatal stroke’s neuropsychological implications. The researchers found that children suffering from neonatal strokes, especially boys, were at high risk for developing cognitive deficits in grade school. They recommended continued follow-ups for children suffering from neonatal strokes, even if they displayed no apparent deficits.

McLinden, A., et al. (2007). Early cognitive outcome after neonatal stroke. Journal of Child Neurology, 22(9), 1111-1116.

This study assessed the cognitive development of neonatal stroke patients. The researchers found that children who suffered a neonatal stroke received low scores on the Bayley Psychomotor Development Index at 12 months after the stroke and the Bayley Mental and Psychomotor Development Indices at 24 months. They also found that neither stroke type nor laterality of infarct affected the outcome. However, the left hemisphere group received higher Bayley Psychomotor Development Index scores than the right hemisphere group. The researchers concluded children suffering from neonatal strokes experienced significant impairments within two years of the strokes.