Most people think stroke is a disease of old age. But newborns also have a higher risk of stroke than older people. Stroke in the first 28 days of life is more common than many people realize. Ironically, stroke in this very young age group is still not realized by many people and ultimately it is not cured.
What is a stroke and how often does it occur?
Stroke is a condition in which blood flow to the brain suddenly stops or decreases, severe enough to cause damage to the brain. There are two types of stroke: ischemic and hemorrhagic.
Ischemic stroke occurs when blood flow to the brain decreases, usually due to a clot, called a thrombus, in one of the blood vessels in the brain. There are two types of ischemic stroke that occur in children, especially newborns: sinovenous thrombosis, in which there is a clot in one of the blood vessels in the brain, and arterial ischemic stroke, in which the clot is in the artery of the brain.
A hemorrhagic stroke occurs when a blood vessel in or close to the brain bursts, causing bleeding in the brain.
Types of stroke
The incidence of stroke in newborns is very high compared to infancy and childhood. Sinovenous thrombosis occurs in one in 6000 newborns, arterial ischemic stroke in one in 4000 newborns, and hemorrhagic stroke occurs in one in 4000 newborns. After passing the newborn period, the risk of stroke decreases significantly, and remains at a low level until old age.
Why do strokes occur in newborns?
In pregnancy, protein travels from the mother's placenta to the fetus, which helps to lower the risk of bleeding. However, this puts the fetus at higher risk for clots and strokes. Sometimes clots can also form in the placenta and move into the fetal blood circulation. This clot may reach the baby's brain and cause a stroke.
Childbirth is one of the moments that are at risk of stroke in newborns. Childbirth can put tremendous strain on the baby's head. Stress on the arteries and veins in the baby's head can lead to clot formation and stroke.
In addition, newborns have thicker blood than us because they have twice as many red blood cells as adults, and this can lead to clots. In the first few days after birth, dehydration can be a problem, which can also lead to blood clots.
What are the symptoms of stroke in newborns?
Stroke in newborns usually shows no clinical symptoms, and often goes unnoticed and therefore not treated until the baby is much older. Symptoms commonly seen in older children and adults are speech disorders, numbness on one side of the body, or imbalance. These are all difficult or even impossible to detect in newborns.
Symptomatic newborns will experience convulsions in the majority. Seizures are the most recognizable sign of stroke in this age group. Seizure symptoms are sometimes difficult to see in newborns, and include the following:
- Repetitive facial movements, including sucking, chewing, or eye movements
- An unusual pedaling motion
- Apnea, or pauses in breathing associated with a slow heart rate
- Jerking movements involving the muscles of the face, tongue, hands, feet, or other parts
- Tense or stiff muscles
- Jerking movements of one arm or leg or the whole body.
One of the main signs of stroke in adults is weakness on one side of the body. However, the brain in newborns is immature and these symptoms may not be visible.
Generally, about 15% of stroke victims in newborns show little movement on one side of their body. Paralysis of one side of the body is easier to see as the baby gets older.
Use of only one hand is a symptom of stroke that may appear anywhere from about six weeks to six months of life. Babies prefer to use their right or left hand and try to reach something using one of those hands. Some parents mistake this for developing a baby, even though it is a sign of a stroke. In healthy children, use of only one hand does not appear until about 12 months of age.
What are the factors that trigger stroke in newborns?
There are several factors that can put a newborn at a higher risk of stroke. When a newborn has a birth defect that includes a hole in the heart, it is easy for the blood clot to pass through other parts of the body, through the heart, and into the brain. If there is a family history of problems with blood clotting, the risk factors are higher in newborns. Serious infections such as sepsis and meningitis can also lead to blood clots. Other risk factors that have been previously described include dehydration and childbirth.
How to diagnose stroke in newborns?
Sometimes a stroke can be diagnosed while the baby is still in the womb. Generally this happens when a birth defect is suspected and the mother is given a test called fetal magnetic resonance imaging (MRI). MRI is very effective in detecting fetal strokes. Some fetuses, if the stroke is severe, can be detected by normal ultrasound during pregnancy. When the baby is born, brain imaging can be done to confirm the diagnosis.
In addition, all newborns who have convulsions should have an ultrasound and a CT of the head. They may also do an MRI. MRI is more sensitive but any sign of stroke can be seen on CT. ideally, the MRI will be done first, followed by another test called magnetic resonance arteriogram (MRA) and a magnetic resonance venogram (MRV), which looks at the blood vessels in the brain in more detail.
How is stroke treated in newborns?
Although a stroke can be diagnosed during pregnancy, the fetus cannot be treated until it is born. When a baby is born, it is impossible to repair the damage caused by the stroke. However, sometimes drugs called anticoagulants can be given to prevent the clot from getting worse. Anticoagulants decrease blood clotting ability. If the baby has had an ischemic stroke, and there is no evidence of bleeding in the brain, anticoagulants can be used to stop the clot from getting worse.
Studies have shown the use of anticoagulants is safe in the treatment of sinovenous thrombosis without bleeding in the brain. Nearly a quarter of newborns with this type of stroke who do not receive an anticoagulant have their blood clotting progressively worse.
On the one hand, newborns who have ischemic artery stroke generally do not need anticoagulants unless there is a blood clot in the heart that can ascend to the brain.
If the baby has had a hemorrhagic stroke, which means that there is bleeding in the brain, anticoagulants should not be used because they will make the bleeding worse.
What steps need to be considered to prevent stroke in newborns?
Since many strokes in newborns occur during pregnancy, every precaution should be taken to ensure that the fetus receives a healthy flow of blood while in the womb. Mothers-to-be should eat right, avoid smoking, and be dehydrated.
If the mother-to-be has a history of clotting disorders, she should get checked out to see if she carries a genetic problem called factor V Leiden, which can cause clotting in babies. If doctors find out that your baby has this condition, they can take the necessary steps to treat it.
When a baby has a lot of red blood cells, which can cause problems during pregnancy or childbirth, clots are more likely to develop in the newborn. Stroke can sometimes be prevented in newborns by giving them a partial blood transfusion in which the blood is diluted with salt.
When a baby is born, dehydration can sometimes cause clots. Get your newborn checked by the doctor if you notice the following signs of dehydration:
- Dry mouth
- Change diapers less than six times a day
- The eyes are waterless and sunken
- The sunken crown, which is the "soft spot" on the top of the baby's head
- Dry skin
It is important for parents to be aware of stroke in newborns. If you think there is something wrong with your baby, get it checked out by a doctor. Don't worry if you think it's too much. Better to be safe than sorry later. If your doctor agrees that your baby has had a stroke, the doctor will refer your baby to a pediatrician who will perform an examination.
