Strokes occur when the blood supply to the brain is blocked, depriving the brain of oxygen. Neonatal stroke is defined as a condition that occurs when a baby’s blood supply suffers a disturbance within the first four weeks of life. It is also called a newborn stroke.
Definition & Facts
A neonatal stroke is a type of pediatric stroke and a type of perinatal stroke. According to the Children's Hemiplegia and Stroke Association, if a stroke occurs in utero at 22 weeks up to the first thirty days of life, it’s considered a perinatal stroke. Neonatal strokes affect newborn infants.
Approximately 1 in 4,000 newborns suffer a neonatal stroke. These strokes can cause developmental delays, intellectual disabilities, and permanent neurological problemss such as hemiplegia (paralysis of half of the body) and cerebral palsy.
Symptoms & Complaints
Sometimes, an infant who has suffered a stroke may favor one hand over the other. This does not mean that the baby is left-handed or right-handed, as babies don’t usually show hand dominance until they are 12 months old. Instead, favoring one hand or the other could be a sign of having had a neonatal stroke
In other cases, the signs of neonatal stroke are evidenced by seizures. Parents and doctors are advised to watch for jerking movements; blank staring; pedaling movements; repetitive eye movements, sucking or chewing; and sleep apnea. Any of these symptoms may be indicative of a neonatal stroke.
The causes of neonatal stroke can be complex. Sometimes, neonatal stroke can occur even if the mother has had a normal, uncomplicated pregnancy, labor and delivery. In some cases, congenital heart defects can cause a stroke.
Neonatal stroke sometimes occurs during labor and delivery, due to the strain that delivery puts on the veins and arteries in the baby’s head. Babies are born with twice as many red blood cells as adults, which can also cause clotting. This can be exacerbated if the baby is dehydrated in the first few days of its life.
Stroke can occur when blood clots form and travel to the baby’s brain which is called an ischemic stroke or when a blood vessel in the brain ruptures which is called a hemorrhagic stroke. Sometimes blood clots can form in the placenta, break loose, and flow in the newborn’s blood. These clots can eventually travel to the brain, causing a stroke.
Diagnosis & Tests
Diagnosing neonatal stroke is complicated by several factors. First, the patient (the baby) is too young to describe how he or she feels or if anything is wrong. Second, because stroke is generally thought of as a condition that affects older adults, neurologists may not be trained to watch for the signs and properly manage the condition of a neonatal stroke.
If stroke is suspected or if an infant has suffered a seizure, medical imaging tests may be performed to confirm whether a neonatal stroke has occurred. Most often, magnetic resonance imaging (MRI) is performed, though computed tomography (CT) scans or CAT scans may also be used as a diagnostic tool.
Other tests that may performed include an electroencephalogram (EEG), especially if seizures or epilepsy are a concern; tests to detect and identify blood clot disorders (coagulopathy); and educational or neuropsychological testing, if the child is older and has exhibited signs of learning disabilities.
Treatment & Therapy
A child who has experienced a neonatal stroke may be under the care of a team of specialists, including pediatricians, neurologist, orthopedic surgeon and neurosurgeon. These professionals may recommend a number of treatments or therapies. Unfortunately, many treatments for neonatal stroke are experimental.
Inducing hypothermia (therapeutic hypothermia) is one way to treat stroke. Drastically lowering the newborn’s temperature keeps the brain from overreacting to an increase of blood flow in the brain, staving off the stroke and its consequences.
Another treatment is hyperbaric oxygen therapy, which involves immersing the baby in an environment with 100% oxygen. This allows oxygen to course through the body, warding off the consequences of oxygen deprivation, such as permanent brain damage. Anticoagulants, such as urokinase or heparin, may also be administered.
There are also a number of treatments for the effects that neonatal stroke may have on a child's development and functioning which may persist throughout a child's life. Speech therapy may be necessary, while behavioral issues may require the intervention of a child psychologist.
Rehabilitative therapy may be required to treat paralysis or weakness in limbs that have resulted from stroke. Constraint-induced movement therapy which involves using a cast or splint to restrain the unaffected limb thereby forcing the patient to use the affected limb has shown some effectiveness in adults and is being evaluated for use in children.
Additional types of physical therapy and occupational therapy may include stretching exercises at home and regular monitoring by a qualified medical professional. Splints or braces may help position limbs. Surgeries such as tendon lengthening can restore function to impacted limbs.
Though experimental, botox injections can help relax tense muscles in children who have suffered neonatal stroke. There is also some evidence showing that alternative treatments, such as acupuncture or medical massage, may be safe to try.
Prevention & Prophylaxis
If the mother has a known history of clotting disorders, the fetus should be tested for the disorder as well in utero, so that steps can be taken to mitigate the effects. After the baby is born, a blood transfusion can reduce the amount of red blood cells in the body. In addition, parents should watch for signs of dehydration in the first few days of life, including dry mouth, sunken eyes, dry skin, and fewer than six wet diapers a day.