INFANT STROKES
Infant stroke is something most parents-to-be would never even consider worrying about- the fact that newborn infants can suffer a stroke, and it might not be detected by the doctor.
Now, new research says strokes in children are a significant cause of long-term disability.
Believe it or not, infant strokes are a very common phenomenon. And it can happen in otherwise healthy babies.
Now, this new study shows the majority of newborns who experience a stroke around the time of birth will develop neurologic problems such as cerebral palsy and epilepsy.
Dr. Deborah Campbell, Director of Neonatology at Montefiore Medical Center, says, “Many babies are perfectly well even though they have experienced a stroke. They really are only identified early on if the baby shows seizures shortly after a birth, has breathing difficulties, or has a difficult start at birth. That acts as a trigger that prompts more investigation.”
According to new research in the Annals of Neurology, the overall rate of infant strokes during labor and delivery, or in the month after birth, is about 1 in 5,000 live births. However, this number is likely low; the study probably missed some cases.
And while previous studies suggested that approximately half of all infants with stroke at or near the time of birth have a normal outcome, there is new, disturbing information: four of five newborn infants who experience a stroke around the time of birth will develop long term neurologic disorders.
The most common disability, found in 58 percent of perinatal stroke survivors, was cerebral palsy, a diagnosis that describes children with problems ranging from clumsy movement to severe weakness.
Epilepsy was seen in 39 percent of infants suffering a stroke, language delay was seen in one in four stroke infants, and behavioral problems, including attention deficit hyperactivity disorder was seen in 22 percent.
“In addition we see that some of the children will have some learning difficulties behavioral difficulties in about a quarter of the children they will have language delay,” says Dr. Campbell.
But the question is, how do you diagnose infant stroke, and what do you do about it?
Infant strokes must be confirmed by brain imaging, such as CAT scans or MRIs. Many children with vague symptoms suggestive of infant stroke don’t get one. Yet the larger the injury seen on imaging, the more likely the child was to develop cerebral palsy.
“It’s not a simple as having a list of risk factors and being able to say this particular pregnancy or this particular baby is the one that is going to experience this. There is much we need to learn and about infant strokes,” states Dr. Campbell.
Cerebral palsy was more likely to occur in infants who had no symptoms early in life.
The stroke was typically discovered months after birth when the child was noted to have decreased use of one hand. These children were more likely to have sustained injury to parts of the brain that control movement.
While the cause of infant strokes is still not known, the authors say infants with unexplained seizures or weakness on one side of the body should be evaluated by a neurologist, and should receive a head imaging study to evaluate for perinatal stroke.
Several large studies into why infant strokes occur are currently underway in the U.S., Canada, and Europe.
The authors did not find a single case of infant stroke recurrence, supporting the argument that these children should not be placed on prophylactic anti-stroke medicines.
Attention should be targeted towards looking at the parents, and whether there is a family history of clotting problems. If so, a hematologist and high risk OB should get involved.
For more information on infant stroke, and on this study, go to
http://www.interscience.wiley.com/journal/ana
http://www.pediatricstroke.org/
Related Stories Links:
|