Objective Few data regarding causes and outcome of hemorrhagic stroke (HS) in term neonates are available. We characterized risk factors, mechanism, and short-term outcomes in term and late preterm neonates with acute HS. Design Prospective cohort. Setting Single-center tertiary care stroke registry. Subjects Term and late preterm neonates (≥34 weeks gestation) born 2004-2010 with acute HS ≤28 days of life were identified, and clinical information was abstracted. Short-term outcomes were assessed via standardized neurological exam and rated using the Pediatric Stroke Outcome Measure (PSOM). Results Among 42 subjects, median gestational age was 39.7 weeks [interquartile range (IQR) 38-40.7 weeks]. Diagnosis occurred at a median of 1 day (IQR 0-7 days) after delivery. Twenty-seven (64%) had both intraparenchymal and intraventricular hemorrhage. Mechanism was hemorrhagic transformation of venous or arterial infarction in 22 (53%). Major risk factors included congenital heart disease (CHD), fetal distress, and hemostatic abnormalities. Common presentations included seizure, apnea, and poor feeding or vomiting. Acute hydrocephalus was common. Mortality was 12%. Follow-up occurred in 36/37 survivors at a median of 1 year (IQR 0.5-2.0). Among 17/36 survivors evaluated in stroke clinic, 47% demonstrated neurologic deficits. Deficits were mild (PSOM 0.5-1.5) in 9/36 (25%), and moderate-to-severe (PSOM ≥ 2.0) in 8/36 (22%). Conclusions In our cohort with acute HS, most presented with seizures, apnea, and/or poor feeding. Fetal distress and CHD were common. Nearly two-thirds had intraparenchymal with intraventricular hemorrhage. Over half were due to hemorrhagic transformation of infarction. Short-term neurologic deficits were present in 47% of survivors.

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Background: Preterm infants are at risk for neurodevelopmental impairment. Intrauterine growth restriction (IUGR) further increases this risk. Brain imaging studies are often utilized at or near term-equivalent age to determine later prognosis. Objective: To evaluate the association between intrauterine growth and regional brain volume on MRI scans performed in preterm infants at or near term-equivalent age. Methods: This is a retrospective case-control study of 24 infants born at gestational age ≤30 weeks and cared for in a large, inner-city, academic neonatal intensive-care unit from 2012 to 2013. Each IUGR infant was matched with 1-2 appropriate for gestational age (AGA) infants who served as controls. Predischarge MRI scans routinely obtained at ≥36 weeks' adjusted age were analyzed for regional brain volumetric differences. We examined the association between IUGR and thalamic, basal ganglion, and cerebellar brain volumes in these preterm infants. Results: Compared to AGA infants, IUGR infants had a smaller thalamus (7.88 vs. 5.87 mL, p = 0.001) and basal ganglion (8.87 vs. 6.92 mL, p = 0.002) volumes. There was no difference in cerebellar volumes between the two study groups. Linear regression analyses revealed similar trends in the associations between IUGR and brain volumes after adjusting for sex, gestational age at birth, and postconceptual age and weight at MRI. Conclusions: Thalamus and basal ganglion volumes are reduced in growth-restricted preterm infants. These differences may preferentially impact neurodevelopmental outcomes. Further research is needed to explore these relationships.