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Periventricular Leukomalacia (PVL)

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If your child has been diagnosed with Periventricular Leukomalacia (PVL), you may be wondering what this condition actually is, how it develops, and if the medical professionals involved in your and your baby’s care may have taken steps to prevent it. PVL is among the primary causes of cerebral palsy and it is the most common form of brain injury affecting premature infants. The condition, which occurs when there is cell death in the white matter of the brain, is also linked with oxygen deprivation prior to, during, or immediately after birth. In some cases, such lack of oxygen occurs due to negligence during labor and delivery. The following provides you with more information about periventricular leukomalacia, risk factors for the condition, preventive measures that may have been taken to protect your baby’s health and well-being, and potential forms of malpractice that may precipitate PVL. If you would like to discuss your child’s case with an experienced New Jersey attorney who can advise you of your rights and assess your potential grounds for a lawsuit, call 866-708-8617 or contact our team online today.

What is Periventricular Leukomalacia (PVL)?

Periventricular leukomalacia (PVL) is a type of brain injury that occurs most often in utero, affecting fetuses or recently delivered babies. The condition occurs when the brain’s white matter softens and dies, disrupting the communication network of nerve cells that bridges the gaps between the spinal cord and one part of the brain and another. Located on the sides of the uppermost portion of the brain, white matter contains vital neural connectors responsible for bodily movement and mental functioning. When white matter is damaged or dies, the affected child’s symptoms can range from no visible impairment, to serious mental and motor dysfunction, or even death. The condition often leads to muscle rigidity or spasticity, cognitive deficits, coordination problems, vision impairment (cross eyes or blindness), hearing dysfunction, quadriplegia and cerebral palsy, depending on the extent of the damage. In fact, PLV is one of the leading causes of cerebral palsy.

What are the Risk Factors for Periventricular Leukomalacia?

While its exact causes are unknown, PLV develops during pregnancy or delivery when the baby’s blood vessels deliver reduced or deoxygenated blood to the periventricular brain area (near the cerebral spinal fluid-filled ventricles), when the mother develops an infection during the gestational period, or when brain bleeds occur. The cells that die due to lack of blood or oxygen form fluid-filled pockets in the brain, which are essentially dead neurological zones. The condition arises more often, but not exclusively, in preterm infants (earlier than 30 weeks), who typically have more delicate brain tissue and are generally more vulnerable to birth injuries and serious medical problems. 26 to 34-week old fetuses are most susceptible, as their vascular network can be damaged by fluctuating blood pressure and external forces, leading to hemorrhage and death of critical white matter. Other potential risk factors for PVL include:

  • Premature rupture of the amniotic sac
  • Multiple births
  • Placental defects
  • Funisitis: umbilical cord infection
  • Amniotic fluid infection; and
  • Uterine infection

In addition, vulnerable infants born with hypotension (low blood pressure), acidosis (high acid in the bodily fluids), hypocarbia (no carbon dioxide in blood), or hypoxemia (deficient oxygen in the blood), may be more likely to develop PVL.

What are the Signs and Symptoms of PVL?

A direct causal link for periventricular leukomalacia remains unclear and symptoms are not uniform, ranging from mild to severe. However, PLV manifests most often in babies as spastic diplegia, a type of cerebral palsy characterized by stiff, contracted muscles, usually along the leg. The symptoms of PVL can be confused with other disorders so early and accurate diagnosis is imperative. Some of the most common symptoms of periventricular leukomalacia include:

  • Cognitive impairments
  • Eyes turned in opposite directions (cross-eyes) and difficulty controlling eye movement
  • Hearing problems
  • Vision problems
  • Retinopathy of prematurity: enlarged retina that can lead to detachment and blindness
  • Muscle tightness or rigidity
  • Quadriplegia: paralysis of both arms and both legs

When it comes to PVL, diagnosis is based on health history, physical examination and tests such as cranial ultrasound, CT and MRI. Imaging procedures may be used to find cysts or spaces in the baby’s brain. Sadly, there is no cure for PVL. Children with PVL may improve function and overall quality of life with physical, speech and occupational therapeutic treatment. It is also important to note that for children affected by periventricular leukomalacia, the extent of the damage may take years to fully materialize. The right specialist to recognize developmental symptoms and conduct regular medical screenings must oversee an infant’s development soon after a PVL diagnosis.

Preventive Measures for Periventricular Leukomalacia

Early detection may be of some preventative help. For example, testing for uterine infections while the fetus is in the womb may minimize possible detriment to both mother and child. Throughout pregnancy, doctors should constantly be aware of the potential for maternal infection and take further steps to diagnose and treat infections in the mother that may affect the fetus.

Screening for risks in early pregnancy may prove useful to address potential problems, while preparation for potential outcomes due to PVL can also aid in management of symptoms. Of course, pregnant women maintaining their overall health by eating a well balanced diet and eliminating harmful habits that may induce PLV, like excessive caffeine, smoking tobacco and ingesting harmful substances (especially cocaine, which has been linked to PLV), are all advisable precautions.

Negligence Preparing for Birth may Lead to PVL

Since PVL is especially prevalent in premature babies, healthcare teams delivering at-risk infants must be extremely vigilant to monitor fetal heart rate, be ready to perform an emergency caesarean section, and ensure prevention and preparation for complications as much as possible. For instance, perhaps after discovering your baby’s heart rate was elevated and he or she was in fetal distress, your doctor eventually performed a caesarean section. Moments can prove permanent or even fatal when a fetus is in distress, so failure to deliver a baby sooner may prevent brain damage in certain scenarios. While PLV can strike for no preventable reason in some cases, healthcare providers may also make mistakes, not detecting problems that could cause oxygen deprivation, such as nuchal cord (umbilical cord wrapped around baby’s neck), improper application of forceps or vacuum extractors, failure to appropriately address preterm contractions, failure to detect or treat infection, premature rupture of membranes, and a myriad of other conditions or symptoms that require immediate and appropriate medical intervention.

Child Diagnosed with PVL in NJ, What are my Rights?

Babies born with Periventricular Leukomalacia may require extensive if not life-long physical, occupational and speech therapy, amounting to thousands if not millions of dollars in medical bills. If your doctor negligently failed to monitor your at-risk pregnancy, failed to perform a timely caesarean section, or otherwise provided inadequate care that may have prevented your baby’s brain injury, you may be compensated through legal action. New Jersey provides you with options to pursue compensation for your child’s previous and ongoing care, as well as other damages, including pain and suffering. Consult with our knowledgeable team of medical malpractice attorneys in NJ to learn more about your legal options. We can be reached anytime at 866-708-8617 to provide you with a free consultation.

Resources:

Periventricular Leukomalacia (PVL) in Children

Periventricular Leukomalacia Information Page

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