Stroke risk highest in babies’ first week of life

Babies in their first week of life are more susceptible to having a stroke than at any other time in their lives, but are also least likely to be diagnosed, according to a world expert in newborn medicine.

Prof Terrie Inder, department chair at Brigham and Women's Hospital, Harvard Medical School, and Prof Geraldine Boylan, director, Infant Research Centre and professor of neonatal physiology at UCC, Cork

The upshot for a child where stroke is not diagnosed is that they could go on to develop cerebral palsy (CP) whereas, with early pick-up and proper rehabilitation, there was the potential to prevent CP, according to Terrie Inder, the Mary Ellen Avery professor of paediatrics in the field of newborn medicine at Harvard Medical School.

Prof Inder, who will address day two of a conference on neonatal brain monitoring and neuroprotection in Cork today organised by Infant, Ireland’s only perinatal research centre, said because babies cannot verbalise, it was difficult to diagnose neonatal stroke.

In Brigham and Women’s Hospital in Boston, where Prof Inder is chair of the department of paediatric medicine, they routinely use MRI scans where there are concerns about a newborn’s brain activity.

She said that through use of MRI and other brain-monitoring techniques, there had been a reduction in the risk of CP in premature babies from 10% to 5%.

She said MRI was “more powerful than any other tool” in diagnosing strokes in newborns. Yet Holles St Hospital in Dublin did not have access to MRI scans until recently and babies had to be transported elsewhere for scans, said Prof Inder.

“If a baby on the postnatal ward is not feeding, how do we know what is wrong?” she said. “You can put on the brainwave equipment to monitor the brain’s activity and if it looks unusual, you do an MRI. If you find something, you can start rehab. It’s very effective at this early stage because the baby’s brain is still “working out the house”, and is more flexible and adaptable at that stage.”

Otherwise, the abnormality may not be picked up until the baby started missing developmental milestones at a year or two old, delaying intervention and leading to poorer outcomes.

Prof Inder said there was also a need for baby to start life in “a gentle environment”.

“We know now if you take care of the baby in a very gentle way, it’s very important for their brain,” she said.

“It is very important for the brain for the baby to be held and nurtured and hear its parents’ voices. It sounds silly, but we have seen in our imaging studies how powerful this nurturing is. We see changes in the way the brain develops. ”

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