ObjectiveTo assess the incidence, risk factors, and clinical characteristics of perinatal stroke in Beijing.MethodsThis multicenter prospective study included all the live births from 17 representative maternal delivery hospitals in Beijing from March 1, 2019 to February 29, 2020. Neonates with a stroke were assigned to the study group. Clinical data, including general information, clinical manifestations, and risk factors, were collected. Up until 18 months after birth, neonates were routinely assessed according to the Ages and Stages Questionnaire (ASQ) and/or the Bayley scale. Statistical analysis was done using the chi-squared, t-tests, and logistic regression analysis using SPSS version 26.0.OutcomesIn total, 27 cases were identified and the incidence of perinatal stroke in Beijing was 1/2,660 live births, including 1/5,985 for ischemic stroke and 1/4,788 for hemorrhagic stroke. Seventeen cases (62.96%) of acute symptomatic stroke and convulsions within 72 h (10 cases, 37.04%) were the most common presentations. Ten patients showed no neurological symptoms and were found to have had a stroke through routine cranial ultrasonography after being hospitalized for non-neurological diseases. The risk factors include primiparity, placental or uterine abruption/acute chorioamnionitis, intrauterine distress, asphyxia, and severe infection. In the study group, 11.1% (3/27) of patients had adverse neurodevelopmental outcomes. The patients in the study group had lower scores for the ASQ than those in the control group in the communication, gross, and fine motor dimensions.ConclusionThe incidence of perinatal stroke in Beijing was consistent with that in other countries. Routine neuroimaging of infants with risk factors may enable identification of asymptomatic strokes in more patients. Patients who have suffered from a stroke may have neurological sequelae; therefore, early detection, treatment, and regular follow-ups are beneficial for improving their recovery outcomes.
The transport of critically ill newborns makes it possible for many high-risk neonates to survive. Relatively little is known about death factors and the risk assessment of full-term newborns. We compared the effectiveness of neonatal transport scoring methods to predict the mortality risk of full-term out-born infants within the first week after transportation. A retrospective cohort study was conducted in the Neonatal Intensive Care Unit (NICU) of Beijing Children’s Hospital from January 2019 to December 2020. All patients were full-term out-born neonates admitted by our transport team. Each patient was assessed by the following scores: the Transport Risk Index of Physiologic Stability (TRIPS) score; the Mortality Index for Neonatal Transportation (MINT) score; the Transport Related Mortality Score (TREMS); and the Neonatal Critical Illness Score (NCIS). Receiver operating characteristic (ROC) and decision curve analysis (DCA) in the R environment were used to test and compare the effectiveness and clinical utility of these scores in predicting the mortality risk of full-term infants within the 1st week after admission. In total, 368 full-term infants were included (368/770, 47.8% of all transported infants). Within the 1st week after admission, five infants (1.36%, 5/368) died under advanced life support and full treatment, while 24 infants (6.52%, 24/368) died soon after they were discharged against medical advice. The AUCs of the MINT, TRIPS, TREMS and NCIS in the prediction of mortality were 0.822, 0.827, 0.643 and 0.731, respectively (all p<0.05). However, the clinical net benefit was far superior for the MINT and TRIPS scores than for the NCIS and TREMS scores.Conclusions: TRIPS and MINT scores might be more suitable for predicting mortality in full-term out-born neonates in the NICU within the 1st week after transportation.
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