Strokes In Newborns: Can They Live A Normal Life?

Strokes in newborns are rare but can occur in the womb or shortly after birth. The risk of stroke in newborns is 1 in 1,000 live births, and the most common symptom is seizures. Other symptoms include apnea (temporary pauses in breathing), extreme sleepiness, weakness on one side of the body, and feeding difficulties. The effects of a stroke on a newborn may only emerge over time, and can include learning difficulties, communication delays, and vision problems. However, the newborn brain is more plastic and able to recover from stroke than an adult brain, as nerve cells are still forming connections. Treatments for newborn strokes include medication, surgery, and therapeutic hypothermia. While newborn strokes can have lasting effects, early diagnosis and prompt treatment are crucial for improving the chances of recovery.

What are the chances of a newborn surviving a stroke?

A newborn can survive a stroke, but it is a very rare occurrence that can happen to babies born prematurely, at full term, or even before birth. Neonatal stroke, defined as a stroke occurring between birth and 28 days, affects as many as one in 2,500 full-term infants and is even more common in premature babies.

The chances of a newborn surviving a stroke depend on several factors, including the type of stroke, the treatment used, and the speed of diagnosis and treatment. The most common type of neonatal stroke is an arterial ischemic stroke, caused by a blood clot or structural abnormality obstructing blood flow within the baby's brain or spinal cord. The other type is a hemorrhagic stroke, which is caused by bleeding in the brain due to blood vessel abnormalities or clotting disorders.

The most common symptom of a neonatal stroke is seizures, which can occur as early as the first day after birth. Other signs include extreme sleepiness, weakness on one side of the body, feeding difficulties, apnea (temporary cessation of breathing), and neurological impairment. However, many babies may not show any noticeable symptoms until they are older, when speech delays and balance difficulties may indicate a previous stroke.

To diagnose a neonatal stroke, physicians will perform brain imaging techniques such as MRI, CT scans, and catheter angiography. Cardiology evaluations, blood tests, genetic studies, and transcranial ultrasound assessments may also be conducted to identify the cause and extent of the stroke.

Treatment options for neonatal stroke include clot-busting medications like tissue plasminogen activator (tPA), which must be administered within 4.5 hours of the onset of symptoms to be effective. In critical cases, endovascular thrombolysis may be performed, involving the direct navigation of a small catheter to the clot site for drug delivery.

While newborn babies can survive a stroke, it can have lasting effects on their health and development. Early diagnosis and prompt treatment are crucial to improving the chances of survival and reducing potential long-term consequences.

What are the signs of a stroke in newborns?

Signs of a Stroke in Newborns

Strokes in newborns often go unrecognized and untreated, as they usually show no clinical symptoms. However, there are some signs that parents and caregivers can watch out for.

Seizures are a common sign of stroke in newborns. These may manifest as repetitive facial movements, such as sucking, chewing, or eye movements, unusual bicycling or pedaling movements, or rhythmic jerking movements involving the muscles of the face, tongue, arms, legs, or other body regions. Seizures can also cause apnea, or pauses in breathing, associated with a slowing of the heart. In some cases, a newborn may experience stiffness or tightening of muscle groups or quick, single jerks involving one arm or leg, or even the whole body.

While weakness on one side of the body is a major sign of stroke in adults, this may not be apparent in newborns due to their immature brains. However, about 15% of newborns who have had a stroke show less movement on one side of their body.

Other potential signs of a stroke in a newborn include:

• Extreme sleepiness and lethargy (hypotonia)
• Weakness on one side of the body (hemiparesis or hemiplegia)
• Feeding difficulties
• Apnea (periods where breathing stops temporarily)
• Neurological impairment
• Vision problems
• Headaches, possibly with vomiting
• Language or speech delays or changes, such as slurring
• Tightness or restricted movement in the arms and legs
• Tendency to favour one hand over the other
• Developmental delays, such as rolling over and crawling later than usual

It is important to note that many babies may not show any noticeable symptoms of a stroke until they are older. Speech delays, balance difficulties, and learning difficulties may be signs that a child had a stroke as a newborn.

What are the risk factors for strokes in newborns?

Risk Factors for Strokes in Newborns

Strokes in newborns (neonatal strokes) occur in babies between birth and 28 days old. They can also happen in babies before birth, during the perinatal period, which is considered to be from week 20 of pregnancy until 28 days after birth.

The exact cause of a newborn's stroke is not always known. However, there are several risk factors that have been identified. Here are the key risk factors for strokes in newborns:

Congenital Heart Disease

Congenital heart disease is a condition that is associated with an increased risk of neonatal stroke. This can include structural abnormalities that obstruct blood flow within the baby's brain or spinal cord, leading to an ischemic stroke.

Blood Clotting Disorders

Blood clotting disorders in either the mother or the baby can increase the risk of a newborn having a stroke. This includes genetic conditions that increase blood clotting. In some cases, a blood clot can develop in the placenta and travel to the baby's brain.

Placental Disorders

Problems with the placenta, such as placental abruption, can decrease the baby's oxygen supply and increase the risk of a stroke.

Infections

Infections in the mother or the baby can be a risk factor for neonatal stroke. This includes infections such as meningitis or chickenpox.

Preeclampsia

Preeclampsia is a condition that occurs during pregnancy and is characterised by high blood pressure and swelling in the hands, feet, and legs. It can increase the risk of a stroke in the baby.

Premature Rupture of Membranes

When a woman's water breaks more than 24 hours before labour starts, it can be a risk factor for a stroke in the newborn.

Birth Trauma

Birth trauma, such as asphyxiation, may also contribute to perinatal strokes. This can include situations where the baby doesn't get enough oxygen during delivery.

Genetic Disorders

Certain genetic disorders, such as Moyamoya disease, can affect the arteries in the brain and increase the risk of a stroke in newborns.

While the risk factors for strokes in newborns are varied, it is important to note that strokes in newborns are rare. They occur in as few as one in 2,500 full-term infants and are even more common in babies born prematurely.

How is newborn stroke treated?

Newborn strokes are often only recognised later in life, when problems arise with a child's motor development or learning. However, if a newborn is displaying symptoms of a stroke, they will usually be given a brain scan to confirm the diagnosis. This could be magnetic resonance imaging (MRI) or computed tomography (CT).

If a stroke is confirmed, the newborn will be treated in a neonatal intensive care or special care baby unit, where they will receive specialist care. This may include the use of clot-busting (thrombolytic) medicine, such as tissue plasminogen activator (tPA), to open up blood vessels obstructed by blood clots. This treatment must be given within the first 4.5 hours after the onset of symptoms to be effective. In some cases, endovascular thrombolysis may be performed, which involves navigating a small catheter directly into the area of the clot and delivering clot-dissolving drugs.

If thrombolytic treatment isn't an option, the focus will be on providing the best neuroprotective care to limit further damage to the brain. This involves maintaining high blood oxygen levels and optimal blood pressure to ensure the brain receives adequate blood flow and oxygen, as well as controlling blood glucose levels and treating fever, which can worsen brain injury.

After the acute period, children will be closely monitored by a team of specialists, including a child neurologist, hematologist, physiatrist, neuropsychologist, neuroradiologist, and occupational and physical therapists. A comprehensive rehabilitation plan will be created to address the long-term consequences of the stroke, which may include physical, occupational, vision, speech, and language therapies.

What are the long-term effects of a stroke on a newborn?

A stroke in a newborn baby, or a neonatal stroke, can have several long-term effects on the child. While some babies may not show any noticeable symptoms of a stroke until they are older, others may experience:

• Seizures, which can vary in severity from the child staring into space to violent shaking of an arm or leg.
• Weakness on one side of the body, known as hemiplegia or unilateral cerebral palsy.
• Fatigue and tiredness, which can manifest as behavioural difficulties or frustration, especially when in a noisy and busy environment.
• Learning difficulties or communication delays.
• Vision problems.
• Speech delays and balance difficulties.
• Developmental delays, such as rolling over and crawling later than usual.

It is important to note that the effects of a stroke on a newborn can vary depending on the type of stroke, its severity, the treatment used, and the overall health of the baby. Early diagnosis and prompt treatment are crucial to improving the long-term outcomes for newborns who have experienced a stroke.

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