September 21st, 2020|
Prematurity is a leading cause of neonatal mortality and morbidity. It is considered to be a risk factor for cerebral palsy, and cognitive dysfunction.
Prematurity can contribute to many of the abnormalities seen on magnetic resonance imaging (MRI) of the brain. Some of the patterns associated with prematurity include:
- Periventricular Leukomalacia (PVL)
- Persistent Pulmonary Hypertension (PPHN)
- Intra-ventricular Hemorrhage (IVH)
Periventricular leukomalacia and intra-ventricular hemorrhage, however, can also be caused by birth asphyxia. Birth asphyxia can occur in the anti-natal (before birth) period, during labor and delivery, or in the neonatal (newborn) period. But because these brain abnormalities are commonly associated with prematurity, there may be a tendency on the part of healthcare providers to blame them on the child’s prematurity. Often, however, that is not the case.
Periventricular Leukomalacia (PVL)
PVL is a condition characterized by cystic formation in the white matter surrounding the ventricles (fluid reservoirs) of the brain. The white matter of the brain is particularly vulnerable to changes in blood flow to the area resulting in hypoxia (reduction of oxygenation), especially prior to 32 weeks of gestation. When this occurs, the cells of the white matter can die, and there will be fluid filled pockets (cysts) in the areas around the ventricle where there should be white matter instead. This can result in both cognitive and motor dysfunction in the child. But it is well known that PVL has a multitude of causes other than prematurity, which includes asphyxia immediately before, during, and after labor and delivery.
Thus, if your child had a difficult delivery and/or was very depressed at birth and ultimately develops PVL, you would be well advised to find out why, particularly if the child were born after 30 weeks of gestation.
Persistent Pulmonary Hypertension (PPHN)
PPHN is the condition of high blood pressure in the blood vessels which lead from the heart to the lungs. During fetal development, because the baby receives oxygen through the umbilical cord and not the lungs, the lungs maintain high blood pressure to re-direct oxygen to other vital organs. After delivery, when the baby begins breathing, the blood pressure in the lungs would normally fall and blood flow to the lungs increase. In babies with PPHN, however, the pressure in the lungs stay high, causing blood to be directed away from the lungs. This can occur as a result of prematurity, but also occurs commonly due to asphyxia.
Intra-ventricular Hemorrhage (IVH)
IVH is bleeding inside or around the ventricles in the brain. Bleeding in the brain can put pressure on the nerve cells causing damage. Bleeding in the brain can also result in adequate blood cell supply to the tissues of the brain (ischemia), which can cause neurological injury.
Nurenberg, Paris, Heller & McCarthy have been successful in litigating multiple cases involving neurologic injury in the newborn. In many of those cases, the injury has mistakenly been attributed to prematurity. If you have any questions about whether your child’s neurologic injury is due to prematurity, or negligence, please call us at (216) 621 – 2300 or complete a free initial consultation form online.