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Strokes in babies are a surprisingly common event. About 1 in 4,000 newborns has a stroke during or shortly after delivery. The event is so common there are even terms for it. A perinatal stroke occurs during the first seven days of an infant's life. A neonatal stroke occurs during the first 28 days of an infant's life. All perinatal strokes are neonatal strokes, although not all neonatal strokes are perinatal strokes.

A stroke is an interruption of blood supply to the brain. Sometimes the cause of a baby's stroke is very obvious. A breech birth (buttocks first) or an umbilical cord wrapped around the baby's neck will result in interruption of oxygen. A skilled OB-GYN knows how to deal with these issues; Caesarian delivery may be necessary to prevent stroke in children born with these complications during labor. 

However, sometimes a neonatal stroke is tied to other issues:

  • Mothers who use cocaine during pregnancy are more likely to bear children who have stroke.
  • Mothers who have coagulation disorders are more likely to bear children who have stroke.
  • Mothers who have diabetes are more likely to bear children who have stroke.
  • Mothers who have infections during pregnancy are more likely to bear children who have stroke.

Mothers by and large, with the exception of cocaine use during pregnancy, can't do anything about the factors that put their babies at greater risk for stroke. However, they can be alert to signs that stroke has occurred.

  • Seizures are the most common outward sign of neonatal stroke. In an infant, it's not always easy to tell that a seizure has occurred. Pedaling movements with the legs, blank stares, single jerks involving an entire limb or the entire body, and apnea, temporary cessation of breathing, are signs that seizure may be in progress.
  • When there are no outward signs of stroke, symptoms may not appear for several months. Numbness, paralysis on one side, and speech difficulties are signs of stroke that simply won't occur in newborns, but become evident as the child matures.
When a stroke is caught as it is happening, there are some innovative treatments that can make a huge difference in outcomes.

One relatively new approach is hypothermia, literally putting the baby on ice to prevent damage to the brain. Why would such a drastic intervention save the baby's brain? When brain cells are deprived oxygen in a stroke, they temporarily go into hibernation. While they are in this "energy saving" mode, they are not damaged. The damage to the brain actually occurs when circulation is restored. A sudden rush of oxygen into the bloodstream in the brain causes brain cells to "burn out" before they have a chance to make tissue-protective antioxidants. Chilling the baby slows down the consumption of oxygen and also prevents the production of tissue-damaging free radicals of oxygen that can cause permanent brain damage.

Another early intervention in neonatal stroke is hyperbaric oxygen therapy. The baby is placed in a high-pressure chamber that allows for higher oxygen concentrations in the bloodstream. This keeps the baby's brain from ever shutting down from oxygen deprivation so that it doesn't have to respond to restored oxygen flow. Usually hyperbaric oxygen therapy would be tried before cold therapies.

Doctors can also use some of the same treatments they use for adults, such as the "clot buster" streptokinase. Early intervention with hyperbaric oxygen therapy, however, is most likely to prevent future complications.

What are the complications of neonatal stroke?

The most common is treatment-resistant epilepsy. Another is cerebral palsy of the "spastic" type. Neurological disability is likely to be long-term, but as many mothers have noted, babies can be tough as nails. A combination of care and determination sometimes works long-term miracles.

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