Neonatal Stroke: When Early Warning Signs Are Missed and Treatment Is Delayed

When people think about stroke, they often associate it with older adults. However, a stroke can occur at any age, including in newborn babies.

Neonatal stroke is uncommon, but when it happens the consequences can be life changing. Early recognition of symptoms and prompt investigation are essential because some causes of neonatal stroke are treatable and delays may increase the risk of permanent injury.

What is a neonatal stroke?

A neonatal stroke occurs when there is a disruption to the blood supply within a baby's brain during the first weeks of life.

There are two main types:

• Arterial ischaemic stroke (AIS) - This occurs when a blood clot blocks an artery supplying part of the brain.
• Cerebral sinovenous thrombosis (CSVT) - This occurs when a blood clot develops in the veins that drain blood away from the brain. The blockage can increase pressure within the brain and cause damage to brain tissue.

Although neonatal stroke is rare, it is one of the causes of seizures and neurological problems in newborn babies.

Why can neonatal stroke happen?

Several factors can increase the risk of stroke in newborn babies.

1. Dehydration and hypernatraemia

One important risk factor is significant dehydration, particularly in babies who are struggling to feed after birth.

Newborn babies, especially in the first days of life, can become dehydrated if they are not taking enough milk. This may lead to high sodium levels in the blood (hypernatraemia), which can affect circulation and increase the risk of blood clot formation.

Warning signs may include:

• Poor feeding
• Excessive sleepiness
• Fewer wet nappies
• Weight loss beyond expected levels
• Jaundice
• Irritability or lethargy

Prompt assessment, feeding support and appropriate treatment can reduce the risk of serious complications.

2. Blood clotting problems

Some babies have inherited or acquired conditions affecting blood clotting, which can increase the risk of thrombosis.

3. Heart conditions

Certain congenital heart conditions may increase the likelihood of clots travelling to the brain.

4. Infection and inflammation

Serious infections can affect the body's clotting system and increase the risk of neurological injury.

When can things go wrong?

The early signs of neonatal stroke can be subtle. Healthcare professionals should be alert to symptoms including:

• Seizures, particularly affecting one side of the body
• Reduced movement of one arm or leg
• Poor feeding
• Excessive sleepiness or reduced responsiveness
• Abnormal muscle tone
• Persistent vomiting
• A baby who appears increasingly unwell

Where there are concerns, appropriate assessment may include blood tests, monitoring, neurological review and brain imaging such as MRI.

Delays in recognising these signs can mean that opportunities to treat the underlying cause and reduce further injury are missed.

Example Case Study

Daniel was born following an uncomplicated pregnancy and was discharged home two days after delivery.

Over the following week, his parents became concerned that he was increasingly sleepy and difficult to feed. He was taking very small amounts of milk and had significantly fewer wet nappies than expected.

When reviewed by healthcare professionals, Daniel had lost more weight than expected and appeared dehydrated. However, his parents were reassured that feeding difficulties were common in newborn babies and he was advised to continue breastfeeding at home.

Over the next 24 hours, Daniel became increasingly lethargic and developed abnormal movements affecting his right arm and leg. He was admitted to hospital where investigations showed severe dehydration, high sodium levels and cerebral sinovenous thrombosis. MRI imaging confirmed that he had suffered a neonatal stroke.

Although treatment was started, Daniel was later diagnosed with weakness affecting the left side of his body and required ongoing physiotherapy.

Daniel's significant weight loss, poor feeding and signs of dehydration should have prompted earlier intervention and further assessment. Earlier recognition and treatment may have reduced the risk of thrombosis and the extent of neurological injury.

Could this amount to medical negligence?

Not every neonatal stroke could have been prevented. Some babies suffer strokes despite appropriate monitoring and treatment. However, concerns may arise where healthcare professionals fail to:

• Recognise signs that a newborn baby is becoming unwell
• Respond appropriately to excessive weight loss or poor feeding
• Investigate dehydration or abnormal blood result
• Recognise seizures or abnormal neurological signs
• Arrange appropriate specialist assessment or brain imaging
• Escalate care when a baby's condition deteriorates

To establish a medical negligence claim, it is generally necessary to show that the care provided fell below an acceptable standard and that earlier intervention would probably have prevented the stroke or reduced the severity of the resulting injury.

Recognising problems early can change outcomes

The first days and weeks after birth are a critical period for a baby's development. Although neonatal stroke is rare, recognising warning signs such as poor feeding, dehydration, seizures or reduced responsiveness can allow doctors to investigate and treat serious conditions before permanent injury occurs. For families affected by neonatal stroke, understanding what happened and whether opportunities for earlier diagnosis or treatment were missed can be an important step in obtaining answers and support.

Further Information

Parents seeking information and support about stroke affecting babies and children may find the Stroke Association’s information and support for childhood stroke helpful.

If you or a family member have been affected by medical negligence, contact our specialist medical negligence lawyers, we will help you to recover appropriate compensation and secure your future.