Brain Problems in the Premature Baby

According to Lucille Packard Children’s Hospital at Stanford University, intraventricular hemorrhage (IVH) most often occurs in premature babies that weigh less than 3 pounds, 5 ounces. This condition occurs when a premature baby’s delicate veins rupture in the brain. This causes blood to pool in the brain, which can damage nerve cells. This condition commonly occurs with respiratory disorders that occur as a result of prematurity.

Symptoms of IVH include:

• low red blood cell levels, or anemia
• bulging or swelling soft spots
• high-pitched cry
• low heart rate
• periods of stopping breathing, or apnea
• seizures
• weak suck when feeding

A doctor diagnoses IVH by considering a baby’s medical history, conducting a physical exam, and taking imaging studies. These include an ultrasound of the head. This ultrasound can help determine how much bleeding is present in a baby’s head. A doctor will assign a “grade” to the hemorrhage. The higher the grade, the more significant the damage is likely to be.

• Grade 1: Bleeding occurs in a small area of the ventricles of the brain.
• Grade 2: Bleeding occurs inside the ventricles.
• Grade 3: The amount of bleeding is so significant that it causes the ventricles to enlarge.
• Grade 4: Bleeding goes not only into the ventricles, but also into the brain tissues around the ventricles.

Grades 1 and 2 aren’t associated with serious or long-lasting symptoms. However, grades 3 and 4 can result in long-term symptoms for a baby. Unfortunately, there are no specific treatments for IVH. Instead, doctors treat a baby’s symptoms that can manifest due to the condition. There’s also no way to prevent the condition from occurring.

Periventricular leukomalacia, also known as PVL, is a brain-related condition that’s closely tied to premature babies. According to Boston Children’s Hospital, PVL is the second-most common complication involving the nervous system in premature babies.

PVL is a condition that causes damage to the nerves in the brain that are responsible for controlling movements. The symptoms of the condition can include:

• jerking or spastic muscles
• muscles that are resistant to motion
• tight muscles
• weak muscles

Babies born with this condition are at greater risk for cerebral palsy and developmental delays. PVL can also occur with IVH.

Doctors don’t know exactly why PVL occurs. However, they do understand that PVL damages the area of the brain called white matter. This area is especially vulnerable to damage. Babies at greater risk for developing PVL include those born under the following conditions:

• The babies were born before 30 weeks.
• The mothers experienced an early rupture of membrane.
• The mothers were diagnosed with an infection inside the uterus.

Doctors diagnose PVL through a medical history, physical exam, and through imaging studies. These include a cranial ultrasound and magnetic resonance imaging (MRI) study.

Although there are no treatments for PVL, doctors can recommend therapists to help with physical or developmental concerns for your baby.

Premature and low birthweight babies are associated with greater risk for experiencing cerebral palsy. This condition causes abnormal movements, muscle tone, and posture in a child. Cerebral palsy’s symptoms can vary from mild to severe.

Symptoms associated with cerebral palsy include:

• abnormal posture
• affected range of motion
• difficulty swallowing
• floppiness or rigidity of muscles
• jerking movements
• muscle imbalances
• tremors
• unsteady walking

Doctors don’t know the exact causes of cerebral palsy. The earlier a baby is born, the greater that baby’s risk for cerebral palsy.

Doctors diagnose cerebral palsy through a physical exam, listening to a child’s signs and symptoms, and considering their medical history.

Imaging tests can also show brain abnormalities. Examples include MRI, cranial ultrasound, and CT scan. A doctor may also use a test called an electroencephalogram (EEG) to test the electrical activity of the brain if seizure-like activity is occurring.

Treatments for cerebral palsy can include:

• medications to reduce muscle spasticity
• physical therapy
• occupational therapy
• speech-language therapy

In some cases, a child may need orthopedic surgery to improve range of motion.

Hydrocephalus is a condition where excess fluid accumulates in the brain. This causes widening of the ventricles in the brain that increases pressure on the brain tissue itself.

Hydrocephalus can occur as a complication of IVH. It can also occur in both premature and full-term babies unrelated to IVH. However, the exact cause of hydrocephalus often isn’t known. The condition’s symptoms can vary based on the severity of the condition. Examples include:

• eyes looking downward
• irritability
• larger-than-normal head size
• rapid enlargement of the head
• seizures
• sleepiness
• vomiting

Doctors diagnose hydrocephalus by using imaging techniques. These include MRI, CT, or a cranial ultrasound.

Treatment for hydrocephalus includes inserting a shunt, which helps to move extra fluid from the brain to another part of the body. Some patients with hydrocephalus require a surgical procedure known as ventriculostomy. This invasive procedure creates an alternate method for extra cerebrospinal fluid (CSF) to move away from the brain.

Unfortunately, there are not always ways to prevent a baby from being born prematurely. Engaging in regular prenatal visits with your doctor can help them monitor both your health and that of your baby. Your doctor should monitor you for conditions such as preeclampsia and infections that could lead to premature birth.

Other steps you can take to prevent premature birth include:

• Avoid smoking, drinking alcohol, and taking street drugs.
• Get a flu shot, which can reduce your risk for infection
• Keep your stress as low as possible.
• Protect yourself from infection by the following good practices:
  • Always wash your hands with soap and water.
  • Avoid cat feces, known to transmit infections.
  • Refrain from eating raw meat or fish.
  • Maintain a healthy weight during pregnancy.

You may need to see a specialist known as a perinatologist if you have had a baby born preterm in the past, or if you have other risk factors for a premature delivery. A perinatologist specializes in high-risk pregnancies and will usually monitor you and your baby more carefully during your pregnancy.