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Neurological Disorder of the Newborn

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When anyone plans on having a baby, one of the first things that comes to mind is the hope that the child will be born healthy. It is a perfectly reasonable desire, but what happens when the child is born with a neurological disorder? Neurological disorders in infants are a major concern in today's society and methods of treatment need to be developed further. This paper will discuss some of the most common neurological disorders in newborns as well as touch on some of the rarer, but just as important disorders.

Intraventricular hemorrhage (IVH) is one of the most common neurological disorders in newborns. It is characterized by bleeding inside or around the ventricles. These are the spaces in the brain containing the cerebral spinal fluid. Intraventricular hemorrhage is most common in premature babies, especially very low birthweight babies weighing less than four pounds. 1

Experts are not clear as to why IVH occurs. Bleeding can occur because blood vessels in a premature baby's brain are very fragile and immature and easily rupture. Babies with respiratory problems or other complications of prematurity are more likely to have IVH. The smaller and more premature the baby, the more likely IVH will occur. Nearly all IVH occurs within the first four days of life. Bleeding in the brain can put pressure on the nerve cells and damage them. Severe damage to cells can lead to brain injury. 2

The amount of bleeding varies, and IVH is often described in four levels. In the first level, bleeding occurs just in a small area of the ventricles. In the second level, bleeding also occurs inside the ventricles. Level three occurs when ventricles are enlarged by the blood, and level four is characterized by bleeding into the brain tissues around the ventricles. Levels one and two are most common, and often there are no further complications. Levels three and four are the most serious and may result in long-term brain injury to the baby. 3

There are many visible signs of a baby born with an intraventricular hemorrhage. These include apnea, pale or blue coloring, poor ability to suckle, high-pitched cry, seizures, swelling or bulging of the fontanelles (the soft spots" between the bones of the baby's head), and anemia (low blood count). It may be difficult to diagnose this neurological disorder because symptoms of IVH may resemble other conditions or medical problems. 3

In addition to a complete medical history and a physical examination, an ultrasound of the baby's head is usually used to diagnose IVH. This test uses sound waves to create a picture of internal structures. A cranial ultrasound can view the inside of the baby's brain through the fontanelles. With the ultrasound, the amount of bleeding can be graded into one of the four levels. 1

Unfortunately, there is no highly satisfactory treatment for IVH. One of the only options is to treat any other health problems that may worsen the condition. Although care of sick and premature babies has advanced greatly, it is not possible to prevent IVH from occurring. However, giving the mother corticosteroid medications before delivery has been shown to lower the risk of IVH in the baby. Corticosteroids are a group of hormones that can be used during pregnancy to reduce the immune response in allergic or inflammatory diseases. These steroids are often given to women between 24 and 34 weeks into pregnancy who are at risk of early delivery. Use of corticosteroid medications is somewhat controversial. Researchers found through studies of rodents and rabbits that high doses of corticosteroids consistently caused cleft palates in newborns. Human studies show varied and conflicting results. Sometimes, surgery is necessary to stabilize the condition of the baby. This may occasionally involve placement of a catheter into the baby's skull, although this is rarely necessary in babies because of the flexibility of their skull bones. 2

Another common neurological disease among newborns associated with intraventricular hemorrhage is periventricular leukomalacia (PVL). Periventricular leukomalacia is characterized by the death or damage and softening of the white matter, the inner part of the brain that transmits information between the nerve cells and the spinal cord, as well as from one part of the brain to another.4 With PVL, the area of damaged brain tissue can affect the nerve cells that control motor movements. As the baby grows, the damaged nerve cells cause the muscles to become spastic, or tight, and restrain movement. Babies with PVL have a higher risk of developing cerebral palsy--a group of disorders that prevent the child from controlling their muscles normally--and may have intellectual or learning difficulties. PVL may occur alone or in addition to intraventricular hemorrhage. 5

Along with IVH, there is no obvious reason why PVL occurs. This area of the brain is very susceptible to injury, especially in premature babies whose brain tissues are fragile. PVL may happen when the brain receives too little oxygen. However, it is not clear when the "trigger" for PVL occurs--before, during, or after birth. Like IVH, most babies who develop PVL are premature, especially those born before 30 weeks. Other factors that may be associated with PVL include early rupture of membranes and infection inside the uterus. 6

PVL may not be apparent until later months. Individuals with PVL often exhibit motor problems, but since healthy newborns also are not able to perform many specific motor tasks anyway, it can be difficult to diagnose. Each baby may also experience symptoms differently. The most common symptom of PVL is spastic diplegia, a form of cerebral palsy characterized by tight contracted muscles, especially in the legs. The symptoms of PVL may resemble other conditions or medical problems.4 There are a few different ways to diagnose PVL. Diagnostic procedures for PVL may include a cranial ultrasound. As stated before, a cranial ultrasound uses sound waves to view the baby's brain through the fontanelles. With PVL, the ultrasound will show cysts or hollow places in the brain tissue. Another way to diagnose this neurological disease is through magnetic resonance imaging, or MRI. This test uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of internal structures. MRI may show some of the early changes in the brain tissue that occur with PVL. 6

There are no treatments for PVL. Management of the problems that can result from PVL will be determined based on the baby's time from conception to birth, overall health, and medical history, extent of the condition, the baby's tolerance for specific medications, procedures, or therapies, expectations for the course of the condition, and the parent's opinion or preference.



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