Neurological damage can occur in babies affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT) if severe thrombocytopenia leads to intracranial hemorrhage, also known as bleeding on the brain.
While some babies will make a full recovery following treatment, others may experience long-term or short-term complications. Close monitoring and evaluation of age-related milestones from birth can help you and your doctor detect any short or long-term difficulties.
What is FNAIT?
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare but serious condition that affects 0.1% of pregnancies in which a pregnant mother’s immune system produces antibodies against the platelets of her fetus. This occurs when a fetus inherits platelet antigens from the father that are not compatible with the mother, typically involving a protein called human platelet antigen (HPA). The mother’s immune system recognizes the fetal platelets as foreign, attacking and destroying them, leading to low platelet levels (thrombocytopenia) in the fetus or newborn.
Neurological challenges associated with FNAIT
Intracranial hemorrhages (ICH) are the most dangerous complication of FNAIT, and without early detection and urgent treatment via platelet transfusions, they can cause permanent brain damage or even death. Children who have survived an ICH as part of FNAIT have a 70% to 82% risk of lifelong consequences.
These consequences may include:
- Developmental delays, including language, cognitive function, physical milestones, motor skills
- Seizures
- Behavioral difficulties, including frustration, irritability, difficulty socializing
- Impaired hearing or vision
- Epilepsy
- Cerebral palsy
How are FNAIT-affected children monitored?
Your pediatrician will be your main point of contact, but if you have specific concerns, you may want to consult a neurologist, developmental specialist or a wider multidisciplinary team. This is particularly important in cases of more severe long-term symptoms such as seizures, epilepsy and cerebral palsy.
When trying to determine if your baby has any lasting effects from FNAIT or an ICH, don’t forget that you, your partner and other family members or caretakers know your baby best. In infancy, when monitoring your baby for developmental delays, you may want to watch for:
- Delays in gross motor skills: independently holding their head up, rolling or sitting
- Poor muscle tone and fine motor skills: floppiness, difficulty grasping or reaching.
- Trouble feeding: fussiness or lack of coordination
- Behavioral and emotional responses: irritability, frustration, frequent crying, inability to self-calm
- Impaired cognitive and sensory function: delay in reacting to sounds, facial expressions, light, temperature, pain
- Language delays: lack of cooing, babbling or copying sounds
Early intervention with speech, physical and developmental therapies can help overcome some of these delays.
As childhood progresses, developmental delays will become more obvious and may include:
- Speech: delayed language development or trouble producing words
- Learning difficulties: poor memory, problem-solving and following instructions
- Behavioral challenges: poor social skills, concentration and attention span
- Coordination: lack of fine motor skills and slow reflexes
Ongoing support from pediatric specialists in cognitive behavioral, speech and occupational therapies as well as special education professionals can be instrumental in managing these neurological challenges associated with FNAIT.
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