Putting the pieces together
Posted 3/7/2016 by UHBlog
Proactive care gives in utero stroke survivor a strong start
Gwen Ciccozzi was a typical newborn, spending her days eating and sleeping. But her mom, Rebecca, began to have nagging concerns when Gwen was about 3 months old.
“As Gwen started moving more, we noticed that she seemed to favor her left hand. We joked she may be a lefty,” recalls Rebecca.
Unfortunately, Gwen’s issues didn’t resolve. At her 6-month checkup, it was clear Gwen was not using her right hand purposefully, such as to reach for a toy. University Hospitals Rainbow Babies & Children’s primary care pediatrician Brian Postma, MD, with Kids in the Sun, examined Gwen further and found her entire right side was weaker than her left.
“I suspected Gwen’s weakness stemmed from a brain injury but only an MRI could provide a definitive diagnosis,” says Dr. Postma. “Although we didn’t yet have all the answers, it was important to act quickly.”
Brian Postma, MD
Pediatrician, UH Rainbow Babies & Children’s Hospital
Clinical Instructor, Case Western Reserve University School of Medicine
Dr. Postma referred Gwen to a UH Rainbow Babies & Children’s pediatric neurologist and recommended the family begin immediate rehabilitation therapy.
“Any child experiencing developmental delays for any reason can benefit from early therapy,” says Dr. Postma. “In a young child, the brain is able to compensate for deficiencies and learn to do things other ways. The earlier therapy starts, the better,” he says.
With coordination from Dr. Postma, Rebecca took Gwen to her first physical therapy appointment with UH Rainbow Babies & Children’s pediatric rehabilitation program the next day. Weekly occupational therapy sessions started soon after.
“As a mom, your heart just sinks knowing that something isn’t right with your child. Although we didn’t know what was wrong with Gwen, it was a relief to start therapy. I felt like we were doing something,” says Rebecca.
Understanding the diagnosis
Several weeks after starting therapy, Edward Gilmore, MD, PhD, a pediatric neurologist at UH Rainbow Babies & Children’s Hospital, evaluated Gwen. Following Dr. Gilmore’s visit and an MRI, Gwen’s parents learned Gwen had a stroke in utero, also called perinatal stroke.
Perinatal stroke occurs in about one in 2,800 fetuses. The cause is usually unknown and cannot be prevented. The stroke affected parts of Gwen’s brain responsible for motor skills, language and portions of her visual fields.
“When we learned Gwen’s diagnosis, we were devastated yet hopeful all at the same time. Although doctors have no way of knowing how much Gwen will be able to achieve, we knew we would give her every opportunity to succeed,” says Rebecca.
Benefits of coordinated care
Since her diagnosis, Gwen has kept improving through her weekly therapy sessions. Now 2 years old, Gwen is slowly beginning to use her right hand. She can stand on her own and is able to walk with a walker. She recently even took a few steps on her own. She understands others and is beginning to talk, and she finds happiness in everyday play.
“Gwen loves to brush her teeth, play with her dollhouse and watch her favorite cartoon,” explains Rebecca. “She is hitting developmental milestones – they’re late, but we’re getting there. We are making sure she has every chance.”
As Gwen’s pediatrician, Dr. Postma has played a key role in her care. He recommended speech therapy when Gwen was at the right age, and continues to oversee her therapy plan, coordinate her medical supplies and collaborate with medical specialists. More importantly, he offers encouragement and support as the family follows Gwen’s unanticipated path.
“Dr. Postma listens to us and leads us in the direction we need to go. He puts it all together,” says Rebecca. “I can’t thank our doctors and therapists enough.”
Watch Gwen’s story