Clinical diversity of cerebral sinovenous thrombosis and arterial ischemic stroke in the neonate: a surveillance study.

Abstract

Background Incidence, risk factors, clinical presentation, onset of symptoms and age at diagnosis differ between arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in the neonate. Distinguishing these two entities early and clinically can be of eminent importance. Methods Active surveillance for AIS and CSVT was performed in 345 German pediatric hospitals. Reported cases were validated with questionnaires. Only cases confirmed by cerebral MRI were included in our analysis. Both groups of patients (AIS and CSVT) were compared with regard to age at diagnose, pattern of clinical symptoms and risk factors. Results Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 [95% CI 2.1; 3.9] times higher compared to CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02), to have signs of perinatal acidosis (e.g. umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (p < 0.0001). Conclusion The risk for AIS is about three times higher than for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data point to the need for awareness of CSVT in critical ill infants.

Incidence Estimates of Perinatal Arterial Ischemic Stroke in Preterm- and Term-Born Infants: A National Capture-Recapture Calculation Corrected Surveillance Study

“…Differences in clinical presentation between PAIS and neonatal cerebral sinovenous thrombosis were recently shown [23]. Clinical presentation of preterm-born infants with PAIS appears to be silent or unspecific and differs from term infants, in whom seizures were the leading symptom.…”

Administrative data in pediatric critical care research—Potential, challenges, and future directions

“…In this context, administrative data may be an important future component of observational real-world data to evaluate therapies-possibly enhanced by linking these data to clinical, registry or further administrative data in order to compensate specific weaknesses of each data type (Figure 1). Several examples illustrate the potential of linking different types of data sets, including public and administrative data sets: data collected for a German surveillance study on pediatric rare diseases were linked to ICD10-coded discharge diagnosis from hospital discharge data in order to estimate population-based incidence rates of perinatal arterial ischemic stroke using capture-recapture analyses (45). Two other studies linked results from the national hospital data set with drug prescription data obtained from health insurances to quantify the effect of direct oral anticoagulant prescription on gastrointestinal and genitourinary bleedings in Germany (46, 47).…”