Neonatal Strokes

A neonatal stroke is a stroke that occurs in the first 28 days of life. Neonatal stroke is a medical condition that can occur when the infant’s brain is deprived of the normal amount of blood flow, which delivers oxygen to the brain. This can be a result of a blockage of blood vessels (ischemia) or lack of oxygen supply at the tissue level (hypoxia), or both. Strokes can be caused by medical negligence during labor and delivery, including excessive use of force, use of instruments such as forceps or vacuum during deliveries or failure to properly monitor the fetus.

A parent may not know a neonatal stroke has occurred until later on in his or her child’s development due to a late presentation of symptoms. Therefore, it is important for all parents to understand what the signs and symptoms are of a neonatal stroke.

Symptoms of neonatal stroke include both apparent symptoms and some that are more difficult to perceive. The most common symptom of neonatal stroke is a seizure. Some additional hard-to-detect symptoms include blank staring, pedaling movements with the legs, apnea (periods where breathing stops temporarily), jerking movements, and single jerks involving a single limb or the entire body. Some less common symptoms include extreme sleepiness and lethargy, weakness on one side of the body (hemiparesis), feeding difficulties, apnea and neurological impairment.

In the infant stage, it can be difficult for parents (especially first time parents) to determine when symptoms like sleepiness, lethargy, weakness and feeding difficulties are related to neonatal stroke, as opposed to the normal behaviors of a newborn baby. It is always important to seek immediate medical attention should you believe your baby is showing any sign of a stroke.

Many babies do not show any noticeable symptoms of a stroke until they are older.  It may not be until a baby fails to meet certain developmental benchmarks, such as crawling, walking, and talking that we are able to perceive signs that a child had a stroke as a newborn.  Symptoms such as speech difficulties, imbalance, and numbness on one side of the body may appear, which are often difficult to perceive in the newborn stage.  While physicians believe that neonatal stroke occurs in approximately 1 in every 4,000 births, the occurrence may potentially be much higher, given the amount of undiagnosed strokes.

Neonatal stroke can also be caused by other medical conditions. A common type of neonatal ischemic stroke, Perinatal Arterial Ischemic Stroke (PAIS), occurs when a blood clot, structural abnormality, excessive force or trauma obstructs blood flow within a baby’s brain or spinal cord. A hemorrhagic stroke is the result of bleeding in the brain. Other conditions associated with increased risk for a stroke include sickle cell disease, brain tumors, congenital heart disease, untreated infections, and maternal risk factors such as smoking, cocaine use or diabetes.