Infants who experience intracranial hemorrhage (ICH), which can be caused by fetal and neonatal alloimmune thrombocytopenia (FNAIT), are more likely to develop long-term neurological damage than infants that did not experience ICH.
Potential effects can vary in severity but may include cognitive impairment, learning difficulties, seizures, cerebral palsy and hearing loss. Early detection of ICH and medical intervention can reduce the risk of permanent brain damage. In early childhood, close monitoring is required to identify any potential effect on neurodevelopmental milestones.
How do platelet-related bleeds impact the brain?
In FNAIT-affected fetuses and newborns, platelet levels drop as a result of attacks by maternal antibodies. As the platelets are destroyed, the blood’s ability to clot is dramatically reduced. As a result, minor injuries that cause blood vessels to rupture can lead to life-threatening consequences.
Bleeding on the brain, also known as intracranial hemorrhage (ICH), is the most dangerous potential complication of FNAIT. In 35% of cases, ICH leads to death, and in 83% of children who survive ICH, neurological damage is detected. A small bleed that becomes uncontrolled when it doesn’t clot can progress to blood accumulating in the skull, as it has nowhere else to go. This can obstruct the supply of oxygen to the brain and damage the brain tissue.
How to monitor for subtle signs of learning difficulties
A child who has been affected by FNAIT, either as a fetus or newborn, will be closely monitored by their doctors to determine whether developmental milestones are being met. Subtle learning differences cannot be detected on an MRI or CT scan. A child who has experienced bleeding on the brain as an infant may have a clear scan but still experience motor, learning or attention difficulties.
Monitoring involves a multidisciplinary approach, relying on feedback from immediate family, teachers and caregivers. Your child’s care team will likely recommend routine pediatric follow-up appointments and neuropsychological testing.
If any gaps in neurological development are identified, immediate referral to a speech therapist, occupational therapist or educational support service can have a positive impact.
What learning differences are associated with FNAIT?
Subtle learning differences may become more noticeable during early childhood and are commonly noticed during the transition to preschool. Cognitive impairment and delays in development can be observed when children have trouble focusing on a task and demonstrate a slower processing speed. Their speech, hearing, fine and gross motor skills, coordination and executive function may also be affected.
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