Questions?What Causes Periventricular Leukomalacia?
Periventricular leukomalacia is a type of brain injury that occurs when the white matter around the brain’s fluid-filled ventricles has been injured, has softened, or has died.
Medical researchers are unsure about the exact cause of PVL. However, they believe it is caused by the brain’s white matter not getting enough blood before, during, or after birth.
White matter is located deep inside the brain. It sends information between the nerve cells and the spinal cord and from one part of the brain to another. It helps the body process information and controls motor function.
When these nerve paths are damaged, children may have tight or spastic (shaky) muscles and experience weakness. Infants with PVL are more likely to develop cerebral palsy and often have vision problems, learning disabilities, and other developmental delays.
Periventricular leukomalacia primarily affects premature, low-birthweight babies.
“[Periventricular leukomalacia] is the second most common complication involving the central nervous system in premature infants.”
Every year, PVL affects about 20,000 to 30,000 children born preterm who weigh less than 3.3 pounds, according to Cleveland Clinic. About 7,000 of those children — or as much as 35% — develop cerebral palsy.
If you have questions about whether PVL may have caused your child to develop cerebral palsy or another serious disability, our registered nurses are here to help.
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Quick Facts About Periventricular Leukomalacia Causes
- The exact cause of PVL brain damage is unknown.
- PVL is most common in premature, low-birthweight babies because their brain tissue is extremely fragile.
- The more premature a baby is, the greater the risk of PVL.
- Regardless of the cause, no treatment can reverse the brain damage caused by PVL. However, conditions resulting from PVL are often treated with occupational therapy, physical therapy, and/or speech therapy.
Risk Factors for Periventricular Leukomalacia
While researchers are still investigating potential periventricular leukomalacia causes, they have identified several risk factors that increase the chance that a child will develop this birth injury.
Premature Birth
Prematurity is the biggest risk factor for PVL in infants.
“PVL can happen in any baby. However, the risk is higher in babies who are born preterm. Smaller, younger preterm babies are at higher risk.”
Premature babies — especially infants born before 30 weeks — are more likely to develop PVL than full-term infants (born after 37).
While the area of the brain affected by PVL is vulnerable in all infants, it is even more delicate in premature babies because their brain hasn’t finished developing.
Hypoxia-ischemia
Hypoxia-ischemia occurs when an infant’s brain does not get enough oxygen and blood flow before, during, or shortly after childbirth. This lack of oxygen and blood flow can cause death or damage to brain tissue and result in different types of brain damage, including PVL and hypoxic-ischemic encephalopathy (HIE).
The most common cause of birth asphyxia (oxygen deprivation) is complications arising during childbirth, according to the World Health Organization.
Brain Bleed
PVL can occur alone or with bleeding inside the brain (intraventricular hemorrhage). Brain bleeds often happen when there is birth trauma or a medical professional misuses assistive delivery equipment such as forceps or vacuum extractors.
Infection in the Uterus
When an expectant mother has an infection, her body manufactures proteins called cytokines. These proteins flow into the developing fetus and cause inflammation in the baby’s brain. Too much inflammation can lead to brain damage PVL.
Some examples of maternal infections that can cause fetal brain damage include cytomegalovirus, HIV, and rubella. Additionally, a study published in the medical journal Clinics in Perinatology found a link between chorioamnionitis and PVL.
“Chorioamnionitis is a serious condition in pregnancy when the membranes that surround the fetus and the amniotic fluid are infected by bacteria. It can cause complications for both you and the fetus.”
Early Rupture of the Amniotic Sac
Early rupture of the mother’s membranes (amniotic sac) has been linked to an increased risk of PVL.
There are two types of rupture:
- PROM: Premature rupture of membranes (water breaks after 37-week gestation, but the mother is not in active labor)
- PPROM: Preterm premature rupture of membranes (water breaks before 37 weeks gestation)
PPROM is riskier due to preterm birth. Prolonged membrane rupture increases infection risk and can cause emergencies like placental abruption or umbilical cord prolapse, reducing blood flow and causing hypoxia. These conditions can lead to periventricular leukomalacia.
Download our free Birth Injury Guide right now to learn more about birth injury causes, risk factors, and prevention.
Are Periventricular Leukomalacia Causes Preventable?
Yes, in some cases, periventricular leukomalacia causes may be preventable.
For example, healthcare professionals may be able to treat conditions that can cause a baby’s brain to be deprived of oxygen and lead to PVL.
These conditions include:
- Cerebral vasoconstriction (narrowing of blood vessels)
- Hypotension (low blood pressure)
- Hypoxemia (low level of oxygen in the blood)
Additionally, medical professionals may be able to delay a premature birth, which is the greatest risk factor for PVL.
When a mother shows signs of early labor, a doctor may administer drugs to:
- Help the baby’s brain and lungs develop (most common medication: betamethasone)
- Suppress labor (tocolytic medications can stop preterm contractions)
- Treat or prevent infections in the mother and baby (various antibiotics can be given)
Expectant mothers can take steps to reduce the chance of going into labor early by getting regular prenatal care, managing high blood pressure and diabetes, and maintaining a healthy lifestyle.
Reducing the Severity of PVL
In some cases, doctors may be able to lessen the severity of PVL brain damage in an infant by cooling their head and body and limiting cell death through a process called therapeutic hypothermia. For this to be effective, it is critical to start this within 6 hours after delivery.
Doctors don’t know exactly how therapeutic hypothermia works. However, they think that a lower core temperature slows down the body’s processes and changes the amount of time during which brain damage can occur, according to Nationwide Children’s Hospital.
If you believe your child’s PVL could have been prevented, contact the Birth Injury Justice Center for a free case review.
Medical Negligence as a Cause of Periventricular Leukomalacia
In some cases, periventricular leukomalacia is the result of medical negligence by a health care professional. Medical negligence occurs when a doctor, nurse, or hospital fails to follow the standard of care and causes injury to a patient.
All labor and delivery team members are trained to detect and monitor risks to the mother and child and provide treatment according to the standard of care. When they fail to do so, the results can be catastrophic.
Medical mistakes that can cause PVL include:
- Delayed response to fetal distress
- Delivering a baby vaginally instead of performing an emergency Cesarean section (C-section)
- Failure to detect and treat infections in the mother or baby
- Failure to monitor the mother or baby for signs of potential complications
- Failure to provide respiratory support to an infant after a traumatic delivery
- Improper use of assisted delivery devices
These medical errors can cause a child to suffer permanent disability, which can take a tremendous financial and emotional toll on families.
If you believe medical negligence played a role in your baby developing periventricular leukomalacia, you may be able to pursue compensation to help pay for their treatment. Contact the Birth Injury Justice Center today for a free legal case review.
Periventricular Leukomalacia Causes FAQs
What is periventricular leukomalacia?
Periventricular leukomalacia (PVL) is a type of brain injury that happens when tissue in the white matter (inner part) of the brain has been damaged or has died. Symptoms of PVL can be severe or mild depending on the extent of brain damage. Premature infants are especially at risk.
While the exact cause of PVL is unknown, doctors believe it is caused by the brain’s white matter not getting enough blood before, during, or after childbirth.
Is periventricular leukomalacia brain damage?
Yes, periventricular leukomalacia is a type of brain damage. Specifically, it’s an injury to the periventricular white matter of the brain. This is the inner part of the brain that sends information between the nerve cells and the spinal cord, and from one part of the brain to another.
How do you prevent periventricular leukomalacia?
Doctors may be able to prevent periventricular leukomalacia by delaying a premature birth, which is the greatest risk factor for PVL. In addition, they may be able to treat conditions that can cause an infant’s brain to be deprived of oxygen and lead to PVL.
Expectant mothers can do their part by getting regular prenatal care, managing high blood pressure and diabetes, and avoiding alcohol and drugs.
Can you live a normal life with PVL?
Yes, some children live normal lives with PVL. It depends on how many symptoms they have and how severe they are.
