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Periventricular Leukomalacia

When a baby is born prematurely or with low birthweight, the baby may face a number of potential birth injuries and developmental problems. One of the birth injuries that often affects premature infants is periventricular leukomalacia. Periventricular leukomalacia is a brain injury in babies that causes permanent damage in areas of the brain. 

It is difficult to learn that your newborn has a brain injury. Even more disturbing for parents is learning that the injury could have been prevented. A medical error or negligence by the doctors can increase the risk of a brain injury. If your child suffered a brain injury and you suspect it was caused by medical mistakes, talk to your birth injury attorneys about ways to hold the doctors and hospitals accountable. 

Periventricular Leukomalacia Birth Injury

Periventricular leukomalacia (PVL) is a type of brain injury. PVL is characterized by damaged white matter near the lateral ventricles in the brain. Necrosis, or death of the white-matter brain cells can be caused by encephalopathy. Hypoxic-ischemic encephalopathy (HIE) is brain damage caused by a lack of oxygen that leads to cell death. 

Ischemic injury that leads to PVL often affects newborns. PVL often occurs in an area of the brain that controls motor function. The damage from periventricular leukomalacia can lead to motor control problems, developmental delays, epilepsy, and cerebral palsy. Vision problems, heart problems, breathing difficulty, and loss of organ function may also occur.

The extent of the injury generally depends on how much white matter was damaged. It may be difficult to identify PVL in a newborn. It may take years before parents realize their child has motor function problems or developmental delays. When a parent realizes the extent of their child’s brain injury, years may have passed since the brain damage occurred. 

In infants, motor function problems may show up in the legs. A child who has been affected by PVL may show tight extension or flexing of the leg joints. Infants with PVL may not exhibit the same sleeping, feeding, or playing positions compared to other children. The motor development signs of PVL may continue as the baby grows. 

What Causes Periventricular Leukomalacia?

Damage to the brain is generally caused by decreased blood flow or decreased oxygen flow to the brain. Hypoxia involves reduced blood oxygenation to the brain. Ischemia is diminished blood flow to the brain. The brain requires a steady supply of oxygen and nutrients in order to function, even as the fetus is developing in the womb. Oxygen deprivation to the brain leads to the death of brain cell tissue and neurons. In PVL, cell death involves white matter tissue in the area of the lateral ventricles of the brain.  

There may be many causes of hypoxia or ischemia that leads to PVL. Any problems that decrease blood or oxygen flow to the fetus can cause brain damage, including oxygen deprivation due to: 

  • Umbilical cord problems
  • Maternal high blood pressure
  • Low blood pressure or hypotension
  • Uterine rupture
  • Preeclampsia
  • Eclampsia
  • Placenta previa
  • Anesthesia errors
  • Infection
  • Delayed C-section

Risks for PVL in Premature or Low Birth-Weight Babies

Periventricular leukomalacia is most common in premature infants or babies with low birth weight. In premature infants or babies with fetal growth restriction, the tissue and organs may not be fully developed. Underdeveloped cardiovascular function and immune system development in premature babies can put them at greater risk for damage caused by hypoxia. 

The blood-brain barrier is a system of cells that regulate nutrient flow to the brain. Damage to the glial cells that support the neurons in the brain may be more common in premature newborns. Problems with the blood-brain barrier can occur with underdeveloped babies, maternal infection, fetal infection, or prenatal infection. 

According to the Centers for Disease Control and Prevention (CDC), a premature birth is defined as a baby born before 37 weeks of pregnancy. In 2019, about 10% of babies were born prematurely. Low birthweight is a baby born weighing less than 5 pounds, 8 ounces. Low birthweight can be caused by premature birth or fetal growth restriction, or a baby who is small for their gestational age. Premature and low birthweight babies have a higher risk for many birth complications, including PVL and other brain injuries.

Long-term Effects of Periventricular Leukomalacia 

The extent of the damage caused by periventricular leukomalacia depends on the extent of brain damage. In minor cases, a baby affected by PVL may be able to live a normal life with only minor deficits. More serious PVL damage can cause serious physical and mental disabilities. The most common long-term effects of PVL damage include: 

In a child with severe disabilities, including cerebral palsy, the treatment options may be limited. Instead, the long-term prognosis may have to focus on raising a child with a brain injury and developmental delays. The costs and care associated with raising a child after a brain injury may continue for the rest of the child’s life. Medical treatment and care may include: 

  • Medication
  • Visits to doctors and specialists
  • Physical therapy
  • Behavioral therapy
  • Special education expenses
  • In-home care specialists
  • Medical equipment
  • Assistive equipment
  • Orthotics
  • Home modifications

Cerebral Palsy and Periventricular Leukomalacia

Cerebral palsy is a general term for many types of conditions that affect motor skills and movement control. There are three main types of cerebral palsy: 

  • Spastic CP is the most common cerebral palsy, and includes 80% of all cerebral palsy cases. It involves issues with specific muscle groups that cause stiffness and effect movement.
  • Ataxic CP accounts for 10% of all cerebral palsy cases, and is characterized by involuntary movement, and problems with balance and depth perception.
  • Athetoid CP also appears in 10% of all cerebral palsy cases, and is characterized by uncontrolled and involuntary movements, slurred speech, and slight muscle tone.

Spastic cerebral palsy is commonly associated with children affected by PVL, including increased tightness and muscle tone in the legs. This can cause difficulty walking, loss of limb function, or paralysis. 

Periventricular Leukomalacia Caused by Medical Malpractice

How does a parent find out if periventricular leukomalacia was caused by medical malpractice? The doctors, nurses, hospitals, or healthcare professionals may not admit to making a mistake that could have caused an injury. It is generally up to the parent to contact an experienced birth injury lawyer to find out if there was a mistake, negligence, or error that caused their child’s brain injury. 

If you suffered negligent medical care in Philadelphia, Baltimore, or Washington, D.C., get the answers you need to help your child. Talk to the experienced medical malpractice attorneys at Gilman & Bedigian. Contact Gilman & Bedigian today for a free consultation.

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