Periventricular Leukomalacia (PVL) is a brain injury that affects infants and newborns. PVL means that there was damage or death to the areas of brain tissue around the ventricles or fluid filled areas of the brain. The cell necrosis or brain damage causes “holes” in the brain. Sadly, some parents are told by the neonatologist or neurologist that their child’s brain looks like “swiss cheese.” It is not meant to be mean, but rather explain to the parents the extent of the brain damage that was done to their child. Unfortunately, a baby that is diagnosed with PVL will usually show signs of developmental delays, seizures, and motor control problems and are often eventually diagnosed with Cerebral Palsy (CP) or epilepsy.
PVL is usually caused by a decrease in blood or oxygen (hypoxia and ischemia) to a baby’s brain which causes damage to the glial brain cells, or cells that help support the nerves. Damage to the glial cells lead to damage to the white matter in the brain. There are many different things that can cause a decrease in blood and oxygen to a baby during pregnancy, labor and delivery or birth that your doctor, obstetrician or nurse midwife need to quickly diagnose and treat to help prevent brain damage or PVL in your newborn.
If not, after there is already a lack of blood flow to your baby’s brain or a hypoxic-ischemic injury, it sets off something called an inflammatory response. Immediately after a brain tissue injury, the body releases cytokines or “pro-inflammatory” fighters to try and respond to stop or minimize the brain damage, but instead, the cytokines are actually toxic to a baby’s developing brain and does more damage than good. Head cooling or cooling caps are frequently used to try and stop this inflammatory response or further brain damage in newborns.
If PVL or damage to your baby’s brain white matter occurred, it can lead to developmental delays, spastic muscles, blindness, seizures, or cerebral palsy. Unfortunately, once the damage is done there is no treatment to reverse the PVL or brain damage, only supportive therapies such as early intervention, speech therapy, physical therapy, occupational therapy and other interventions to help your child reach their maximal developmental potentials in addition to medical therapy to help control seizures, epilepsy or spasticity in your child’s muscles.
Any baby who is diagnosed with PVL should be monitored closely by developmental teams or a pediatric neurologist, in addition to the child’s regular pediatrician.
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