Risk factors for perinatal stroke in term infants: A case–control study in Australia

Abstract

Aim The aetiology of perinatal stroke is poorly understood. This study aimed to prospectively confirm the risk factors and identify any previously unknown variables. Methods A prospective case–control study was conducted in Australia. Univariate odds ratios (ORs), associated 95% confidence intervals (CIs) and multivariable logistic regression models fitted with backwards stepwise variable selection were used. Results Sixty perinatal stroke cases reported between 2017 and 2019 included 95% (57/60) with multiple risk factors. Univariate analysis identified emergency caesarean section rather than NVD (P < 0.01), low Apgar score (<7) at 1, 5 and 10 min of age (P < 0.01), resuscitation at birth (P < 0.01), abnormal cord blood gas (P < 0.01), neonatal infection/sepsis (P < 0.01), congenital heart disease (P < 0.01) and hypoglycaemia (P < 0.01) as significant risk factors. Multivariate analysis found smoking during pregnancy (OR: 1.48; 95% CI: 1.09–1.99), 1‐min Apgar score < 7 (OR: 1.54; 95% CI: 1.15–2.08), 10‐min Apgar score < 7 (OR: 1.26; 95% CI: 1.02–1.54) and hypoglycaemia (OR: 1.49; 95% CI: 1.07–2.06). Conclusions Perinatal stroke is associated with multiple risk factors. Exposure to smoking, 10‐min Apgar score < 7, neonatal infection and hypoglycaemia were independent risk factors. Emergency caesarean section, resuscitation at birth and abnormal cord blood gas were additional risk factors.

The contribution of low Apgar scores in identifying neonates with short-term morbidities in a large single center cohort

“…In a review of 501 papers published in 2018–19, the Apgar score was used as a prognostic factor for outcomes in 19%, more than half of these focused on short term morbidities [ 7 ]. Numerous studies have examined the association between low Apgar score and a variety of short-term neonatal morbidities [ 8 – 10 ] but the significance and value of a low Apgar score in identifying newborn infants likely to manifest these morbidities has not been systematically examined.…”

The Contribution of Low Apgar Scores in Identifying Neonates with Short-term Morbidities in a Large Single Center Cohort

“…[3][4][5][6][7] In a review of 501 papers published in 2018-19, the Apgar score was used as a prognostic factor for outcomes in 19%, more than half of these focused on short term morbidities 8 . Numerous studies have examined the association between low Apgar score and a variety of short-term neonatal morbidities [9][10][11] but the signi cance and value of a low Apgar score in identifying newborn infants likely to manifest these morbidities has not been systematically examined.…”