Neonatal Stroke Birth Injuries

When a newborn experiences a disruption of blood flow to the brain during the first weeks of life, the consequences can be profound and lasting. Neonatal stroke is one of the more serious birth injuries that families may face, often diagnosed after unexplained seizures or difficulties with movement and feeding. Understanding what neonatal stroke is, how it happens, and what kinds of support are available can help parents navigate an overwhelming time with greater clarity and confidence.

This page provides medically accurate information about neonatal stroke, including its causes, symptoms, diagnosis, treatment standards, and long-term outcomes. Our goal is to help families recognize the signs, understand their child’s care, and connect with the resources they need to support their baby’s development.

What is a Neonatal Stroke?

Neonatal stroke refers to a disruption of blood flow in an infant’s brain that occurs during the first 28 days of life. This disruption can happen in several ways. Blood flow may be blocked by a clot in an artery, leading to arterial ischemic stroke. Blood vessels in the brain may rupture, causing hemorrhagic stroke. In other cases, a clot may form in one of the veins draining blood from the brain, known as cerebral venous sinus thrombosis.

Neonatal stroke can occur before birth during the perinatal period, during labor and delivery, or in the days immediately following birth. In many cases, the stroke happens without warning and is only identified when a baby shows concerning symptoms such as seizures, stiffness or limpness on one side of the body, or trouble feeding.

The brain injury caused by neonatal stroke can lead to lifelong neurological challenges, including cerebral palsy, epilepsy, learning difficulties, and motor impairments. Early recognition and intervention are critical to improving outcomes.

How Neonatal Stroke Happens

Neonatal stroke results from a combination of maternal, birth-related, and infant factors. While not every stroke can be prevented, understanding the contributing causes can help medical teams recognize at-risk infants and provide more vigilant monitoring.

Maternal and Birth-Related Risk Factors

Several pregnancy and delivery complications are associated with higher stroke risk in newborns:

• Chorioamnionitis, an infection of the placental membranes
• Gestational diabetes
• Placental abnormalities, such as fetal vascular malperfusion, which reduces blood and oxygen delivery to the baby
• Prolonged or difficult labor
• Cesarean delivery, particularly when medically indicated due to fetal distress
• Preterm birth
• Premature rupture of membranes
• Abnormal fetal heart rate tracings during labor, which may signal distress
• Birth trauma, including difficult instrumental deliveries

These conditions can disrupt oxygen delivery, increase inflammation, or contribute to clotting abnormalities, all of which may set the stage for stroke.

Infant Risk Factors

Certain health conditions in the newborn also increase stroke risk:

• Congenital heart disease, which can alter blood flow and promote clot formation
• Clotting or coagulation disorders, which may be inherited or develop after birth
• Infection, including meningitis or sepsis
• Dehydration, which can thicken the blood
• Perinatal hypoxic-ischemic events, where the baby experiences reduced oxygen during birth

In many cases, neonatal stroke results from multiple overlapping factors rather than a single identifiable cause.

Recognizing the Signs

Neonatal stroke often presents subtly, and symptoms may not be immediately obvious. Seizures are the most common presenting sign, occurring in approximately 30 to 66 percent of infants with neonatal stroke. These seizures may involve rhythmic jerking of one side of the body, staring spells, or episodes of stiffening.

Other early signs include abnormal muscle tone, such as unusual stiffness or floppiness, poor feeding or difficulty latching, lethargy or lack of alertness, and asymmetric movement where one arm or leg moves less than the other.

Some infants do not show clear symptoms in the newborn period. Instead, parents or pediatricians notice signs in the first few months of life, such as early handedness, where the baby consistently uses one hand much earlier than expected, or weakness on one side of the body, known as hemiparesis.

Because symptoms can be subtle or delayed, any infant with unexplained seizures, abnormal movements, or feeding difficulties should be evaluated promptly with neuroimaging.

How Neonatal Stroke is Diagnosed

MRI is the gold standard for diagnosing neonatal stroke. It provides detailed images of the brain and can identify the location, size, and type of stroke. MRI is recommended for any infant with suspected neurologic injury, unexplained seizures, or abnormal motor findings.

In most cases, neonatal stroke affects one side of the brain and involves the territory supplied by the middle cerebral artery, which provides blood to large portions of the brain responsible for movement and sensation.

Additional diagnostic tests may include examination and, when available, pathologic evaluation of the placenta to look for signs of infection, clotting, or vascular problems, cardiac evaluation to rule out congenital heart disease or sources of blood clots, and prothrombotic workup to identify inherited or acquired clotting disorders.

These tests help determine whether there is an underlying condition that may require ongoing treatment or monitoring.

Medical Treatment and Care Standards

Acute management of neonatal stroke focuses on stabilizing the infant, controlling seizures, and preventing further injury. This care typically occurs in a neonatal intensive care unit.

Seizure Control

Seizures are treated with antiepileptic medications. Phenobarbital is the first-line drug used in most NICUs. If seizures continue, levetiracetam or other medications may be added. Controlling seizures quickly is important because prolonged or repeated seizures can worsen brain injury.

Supportive Care

Infants are closely monitored for complications such as increased pressure in the brain, difficulty breathing, or changes in blood sugar and electrolytes. Supportive care may include respiratory support, intravenous fluids, and nutritional support if the baby is unable to feed normally.

Thrombolysis and Anticoagulation

Unlike in adults, thrombolytic therapy, which dissolves blood clots, is not recommended for neonatal arterial stroke. The risk of bleeding in the newborn brain is high, and the treatment has not been proven effective in this age group.

However, in certain situations, particularly when a baby has recurrent strokes or congenital heart disease, anticoagulation therapy with heparin, low molecular weight heparin, or aspirin may be considered. These medications are used cautiously and require close monitoring.

Early Rehabilitation

Even in the first weeks of life, early intervention can begin. Physical, occupational, and speech therapists work with infants to support feeding, movement, and development. Starting these therapies early is one of the most important factors in improving long-term outcomes.

Clinical care guidelines have been developed to standardize the evaluation and treatment of neonatal stroke across hospitals. These protocols help ensure that every infant receives appropriate imaging, testing, monitoring, and family education.

What Families Can Expect Over Time

The long-term effects of neonatal stroke vary widely depending on the size and location of the stroke, how quickly it was treated, and the quality of follow-up care. Some children recover remarkably well, while others face significant challenges.

Common Long-Term Outcomes

At two years of age, research shows that approximately 16 to 27 percent of children who had a neonatal stroke develop epilepsy, 16 percent are diagnosed with cerebral palsy, and up to 24 percent require physical, occupational, or speech therapy.

Many children experience motor impairments on one side of the body, known as hemiplegia, which can affect walking, hand use, and coordination. Some also face cognitive delays, learning difficulties, or behavioral challenges as they grow.

Because most neonatal strokes are unilateral, meaning they affect only one side of the brain, many children are able to adapt and develop compensatory skills over time, especially with early and consistent therapy.

Incidence and Awareness

Neonatal stroke affects approximately 1 in 2,500 to 1 in 4,000 live births, though the true incidence may be higher because some cases go undiagnosed or are recognized only later in infancy. Greater awareness among healthcare providers and improved access to MRI have led to earlier and more accurate diagnosis in recent years.

Ongoing Care and Developmental Support

After the acute phase, infants who have had a neonatal stroke require long-term follow-up with a multidisciplinary team. This team often includes a pediatric neurologist, developmental pediatrician, physical therapist, occupational therapist, speech therapist, and social worker.

Children are monitored for developmental milestones, seizures, vision and hearing problems, and motor function. Early identification of delays or complications allows for timely intervention, which can significantly improve quality of life.

Many families benefit from connecting with support organizations that provide education, parent-to-parent connections, and advocacy for long-term care planning. These resources can help parents feel less isolated and more prepared to navigate the healthcare and educational systems.

Resources and Support in New York

New York is home to several major medical centers with specialized programs for infants and children affected by neonatal stroke. Hospitals such as Mount Sinai, NYU Langone, Columbia University Irving Medical Center, Albany Medical Center, and SUNY Upstate Medical University offer multidisciplinary stroke and neurodevelopmental clinics. These clinics provide ongoing evaluation, rehabilitation services, genetic counseling, and family support.

The New York State Department of Health supports statewide stroke centers and resources for families caring for children after stroke, including access to community-based rehabilitation services and social services.

Families can also access state-funded early intervention programs for children from birth to age three. These programs provide therapies and support services at no cost to families, helping children reach their developmental potential during the most critical years of brain development.

NYBirthInjury.com exists to provide trusted information and connect families with qualified medical and support resources throughout New York and across the country.

Current Research and Evolving Standards

Research into neonatal stroke continues to advance. Recent studies have confirmed higher stroke risk among infants exposed to maternal infection, placental malperfusion, or birth trauma. There is also growing awareness of disparities in access to care and outcomes among underserved populations.

Ongoing research is focused on optimizing neuroimaging techniques to detect strokes earlier and more accurately, identifying genetic and immune markers that may predict stroke risk or guide treatment, and improving rehabilitation protocols to enhance motor and cognitive recovery.

Surveillance of neurodevelopmental outcomes and early identification of epilepsy or cerebral palsy remain high priorities. Multi-site clinical guidelines now emphasize standardized care, early intervention, family counseling, and coordinated transition from the NICU to outpatient rehabilitation services.

These advances reflect a commitment to not only saving lives but also improving the quality of life for children affected by neonatal stroke and supporting the families who care for them.

Moving Forward After a Neonatal Stroke

Neonatal stroke is a serious birth injury with lasting effects, but it is not a diagnosis without hope. With prompt recognition, expert medical care, and early intervention, many children go on to lead full and meaningful lives. Understanding the causes, symptoms, and treatment options empowers families to advocate for their child and make informed decisions about care.

If your child has been diagnosed with neonatal stroke, know that you are not alone. Medical teams, therapists, and support networks are available to guide you through every stage of your child’s development. Armed with information and surrounded by the right resources, families can face the challenges of neonatal stroke with resilience and confidence.