While strokes are typically associated with adults, they can also occur in children, including infants before and after birth. Pediatric stroke affects 25 in 100,000 newborns. Children who have experienced a perinatal stroke may be at risk of developing cerebral palsy.

What Is a Perinatal Stroke?

According to the American Heart Association, perinatal strokes include a group of cerebrovascular diseases that damage the brain early in life and contribute to many cases of hemiparetic cerebral palsy, a form of cerebral palsy that affects one arm and leg on one side of the body. A perinatal stroke is a type of baby stroke that occurs in infants between 20 weeks gestation and 28 days after birth.

A perinatal stroke may result from oxygen deprivation in the following situations:

• A clot may form that reduces the flow of oxygenated blood to the brain, also known as ischemia.
• A hemorrhage may interfere with normal blood circulation.
• Hypoxic-ischemic encephalopathy (HIE) may result from a lack of oxygenated blood flow to the brain, and babies diagnosed with HIE may also suffer from a perinatal stroke as a result.

Perinatal strokes are classified according to these time periods:

• Fetal strokes, occurring before and close to birth
• Neonatal, occurring from birth to 28 days after birth
• Presumed perinatal ischemic stroke, a stroke that likely occurred sometime during the neonatal period

Specific types of perinatal strokes include:

• Arterial ischemic stroke
• Cerebral sinovenous thrombosis (CSVT)
• Hemorrhagic stroke
• Periventricular venous infarction (PVI)

A hemorrhagic stroke typically occurs when a blood vessel in the brain ruptures, causing a hemorrhage. An ischemic stroke generally follows from blocked arteries due to blood clots.

How Perinatal Stroke Causes Brain Damage

Perinatal strokes are often difficult to detect. Signs and symptoms commonly associated with strokes in adults, such as numbness on one side of the body and slurred speech, are not detected in the same way in newborns. Fetal strokes may manifest themselves in the following symptoms:

• Apnea
• Feeding difficulties
• Respiratory difficulties
• Seizures
• Weakness or paralysis on one side of the body

In an ischemic stroke, a lack of blood flow to the brain deprives brain tissue from receiving the oxygenated blood it needs and causes brain cells to die. This oxygen deprivation may permanently damage the brain. In a hemorrhagic stroke, a ruptured blood vessel floods the brain with blood, damaging brain cells in the process.

Risk Factors and Causes of Perinatal Stroke and Infant Brain Damage

When babies are born, their bodies contain double the amount of red blood cells as adults. The increased red blood cells allow infants to absorb as much oxygen as possible from the womb. Due to the number of red blood cells present, an infant’s blood is thicker than the blood of a healthy adult, which makes babies susceptible to blood clots and strokes.

Additionally, these risk factors and causes may result in perinatal strokes and infant brain damage:

• Congenital defects: Organ abnormalities, such as a hole in the heart, could enable blood clots to pass more easily from other parts of the body to the brain.
• Dehydration: Dehydration may cause blood to clot and thicken.
• Trauma to the baby’s head during labor or delivery: Pressure on the baby’s head during labor or delivery may lead to blood clots that deprive the brain of oxygen. This can cause a hypoxic-ischemic brain injury or a stroke. Delivery trauma could result from members of the medical team incorrectly using delivery-assisting tools such as forceps or vacuum extractors.

Children who have suffered from a stroke may be at risk of developing hemiplegia, a spastic form of cerebral palsy that weakens or paralyzes one side of a child’s body. Additionally, hemiplegia can result in other conditions such as problems with attention, memory and speech.

Stroke Treatment

Since signs of a stroke in babies are often subtle, medical professionals may request certain diagnostic tests to confirm whether the child has suffered a stroke:

• Blood tests to confirm clotting or infection
• Brain imaging through a CT or MRI scan
• EEG and EKG monitoring
• Lumbar punctures to examine spinal cord fluid for signs of infections or bleeding in the brain

Treating a stroke may involve:

• Anticonvulsant medication to control seizures
• Blood-thinning medications, except in cases of hemorrhagic stroke
• Blood transfusions
• IV fluids
• Oxygen treatments

Since nerve cells in the brains of newborns are still forming connections, the brain may be able to transfer certain functions from a damaged part of the brain to healthier parts of the brain. Perinatal stroke recovery, however, can take time. Additionally, complications such as cerebral palsy, developmental and intellectual disabilities, language difficulties, speech disorders and other conditions may result.

If you believe your child has suffered a stroke that caused cerebral palsy due to medical malpractice, the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs can help. Contact us today for a free consultation.

Reviewed by:
Trish Fletcher, MS, BSN, CRNP, NNP-BC, ALNC
Neonatal Nurse Practitioner | Birth Injury Legal Nurse Consultant

Tricia is a dedicated, focused, Birth Injury Legal Nurse Consultant and Neonatal Nurse Practitioner with more than 25 years of experience. Her strong clinical and critical thinking skills, paired with expertise caring for neonates in a Level III Neonatal Intensive Care Unit (NICU), ensures meticulous medical records review. READ FULL BIO

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