Periventricular Leukomalacia (PVL) is a brain disorder suffered by newborns who are deprived of oxygen during labor, delivery or shortly after delivery. The condition most commonly affects babies who are born prematurely, between 26 and 32 weeks gestation. The oxygen deprivation causes the white matter of the brain, called “leuko,” to die or decay. This occurs around the ventricles of the brain, leading to the name periventricular leukomalacia.
Causes of Oxygen Deprivation Leading to PVL
Although babies born at any stage of gestation may develop PVL, fetuses born prematurely, between 26 and 32 weeks gestation are most vulnerable. Some of the most common causes include:
- An intrauterine bacterial infection which resulted in toxins crossing through the amniotic fluid into the brain of the fetus. The toxins damage the white matter of the brain, causing it to die or decay.
- Mechanical ventilation of newborns, which often occurs in premature births. If not done properly, mechanical ventilation can result in a number of conditions, like acidosis or hypotension, which deprive the brain of oxygen leading to PVL.
- Inflammation of the connective tissue of the umbilical cord, known as funisitis.
- Vaginal bleeding during pregnancy.
- Cocaine use by the pregnant woman.
- Premature rupture of the membranes.
Periventricular Leukomalacia Symptoms
Newborns are likely not to exhibit any initial symptoms, but since the area of the brain affected is where the nerve fibers meet to carry messages from the brain to the muscles, babies must be carefully monitored for problems with motor and intellectual development. They need to be seen regularly by a pediatric neurologist as well as their regular pediatrician since they are likely to develop problems in the future. Between 60 and 100 percent of babies who are diagnosed with PVL develop cerebral palsy.
As the child develops, he or she will demonstrate some or all of the following:
- Intellectual impairment.
- Spastic diplegia, a condition where the limbs are difficult to move due to tight muscles.
- Hearing impairment.
- Visual problems.
- Difficulty with coordination.
An accurate medical history of the mother is important for diagnosis of Periventricular Leukomalacia. Additionally, MRIs of the brain and ultrasounds as well as CT scans of the head of the infant all may be used to determine if the child has PVL. It takes between four and eight weeks for the damage in the brain to be detected with testing. When an at risk infant reaches 30 days old, testing should begin. Negative results prior to that time are not reliable. As the child grows, there will be noticeable delays in all motor functions, such as sitting up alone, crawling, speaking and walking.
Unfortunately, there is no known treatment. Infants who are diagnosed with Periventricular Leukomalacia are monitored for physical and mental developmental delays. Only the symptoms and manifestations can be treated, like massage for spastic muscles, physical and speech therapy and treatment for hearing and vision impairment.
Parents and caregivers must be taught how to care for the disabled child. Depending on the severity of the impairment, caregivers may need to assist with all activities of daily living including dressing, feeding and bathing the developmentally delayed child.
Research continues on how to prevent this brain injury is the major cause of cerebral palsy. The main prevention interventions are:
- Doing everything possible to prevent a premature birth.
- If a premature birth is inevitable, administration of corticosteroids have been found to reduce the risk of PVL.
- All medical personnel involved in labor, delivery and taking care of the infant immediately after delivery must carefully monitor the oxygen levels of the fetus and newborn to be certain there is no deprivation. This includes essential monitoring of the heart rate which is an indication that oxygen levels may be deficient.
- Delay in performing a cesarean section after it becomes obvious the fetus is in distress.
- Early identification and treatment of an intrauterine infection during gestation.
Periventricular Leukomalacia Prognosis
Each case is different and the prognosis depends on the severity of the symptoms. Some are only mildly affected. Others are debilitated for their entire life.
If your baby has been diagnosed with periventricular leukomalacia, contact experienced birth injury attorneys. In many situations, the PVL is due to the failure of health care providers to provide adequate oxygen to the fetus, failure to properly monitor the heart rate and fetal oxygen levels during the labor and delivery process, or a failure to properly diagnose and treat maternal uterine infections. At Davis Levin Livingston, we offer a free case evaluation. We will review the facts and circumstances surrounding your child’s PVL diagnosis and determine if you may have a claim for damages.