Symptomatic Neonatal Arterial Ischemic Stroke: The International Pediatric Stroke Study

Kirton, Adam; Armstrong, Jennifer; Chang, Taeun; deVeber, Gabrielle; Rivkin, Michael J.; Hernández, Marta; Carpenter, Jessica; Yager, Jerome Y.; Lynch, John K.; Ferriero, Donna M.

doi:10.1542/peds.2011-1148

Cited by 228 publications

(228 citation statements)

References 26 publications

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“…8,[19][20][21] It is considered that ischemic perinatal stroke is a multiple-risk problem. 8 However, in a significant number of neonates, provoking factors are not evident.…”

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confidence: 99%

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Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

et al. 2015

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BACKGROUND AND OBJECTIVES: Neonatal arterial ischemic stroke (NAIS) is associated with considerable lifetime burdens such as cerebral palsy, epilepsy, and cognitive impairment. Prospective epidemiologic studies that include outcome assessments are scarce. This study aimed to provide information on the epidemiology, clinical manifestations, infarct characteristics, associated clinical variables, treatment strategies, and outcomes of NAIS in a prospective, population-based cohort of Swiss children. RESULTS: One hundred neonates (67 boys) had a diagnosis of NAIS. The NAIS incidence in Switzerland during this time was 13 (95% confidence interval [CI], 11-17) per 100 000 live births. Seizures were the most common symptom (95%). Eighty-one percent had unilateral (80% left-sided) and 19% had bilateral lesions. Risk factors included maternal risk conditions (32%), birth complications (68%), and neonatal comorbidities (54%). Antithrombotic and antiplatelet therapy use was low (17%). No serious side effects were reported. Two years after birth, 39% were diagnosed with cerebral palsy and 31% had delayed mental performance.CONCLUSIONS: NAIS in Switzerland shows a similar incidence as other population-based studies. About one-third of patients developed cerebral palsy or showed delayed mental performance 2 years after birth, and children with normal mental performance may still develop deficits later in life. WHAT'S KNOWN ON THIS SUBJECT:Neonatal arterial ischemic stroke is associated with later cerebral palsy and cognitive impairment. Many studies on neonatal ischemic stroke are limited by modest sample sizes, and prospective studies that include outcomes assessments are scarce. WHAT THIS STUDY ADDS:Results from this prospective, nationwide, population-based study provide information on the epidemiology, associated clinical variables, clinical manifestation, vascular distribution, and treatment of neonatal arterial ischemic stroke. The study also provides outcomes regarding motor function and cognition.

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“…8,[19][20][21] It is considered that ischemic perinatal stroke is a multiple-risk problem. 8 However, in a significant number of neonates, provoking factors are not evident.…”

mentioning

confidence: 99%

“…8 However, in a significant number of neonates, provoking factors are not evident. 20 Most studies on NAIS have been limited by modest sample sizes and heterogeneous study populations. Because data are limited, treatment concepts are still not evidence based.…”

mentioning

confidence: 99%

Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

et al. 2015

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“…Neonatal encephalopathy -be it manifested by seizures, abnormal tone, or altered level of consciousness -is known to be a common presenting feature of neonatal stroke. 22,23 Moreover, neonates with stroke do not usually require major caseroom resuscitation, a feature that is more common in neonates who have suspected birth asphyxia. 22,23 An Executive Summary by the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy stated that in the context of acute intrapartum hypoxic-ischemic events, '[the] developmental outcome is spastic quadriplegia or dyskinetic cerebral palsy' and that 'other subtypes of cerebral palsy are less likely.'…”

Section: Discussionmentioning

confidence: 99%

“…22,23 Moreover, neonates with stroke do not usually require major caseroom resuscitation, a feature that is more common in neonates who have suspected birth asphyxia. 22,23 An Executive Summary by the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy stated that in the context of acute intrapartum hypoxic-ischemic events, '[the] developmental outcome is spastic quadriplegia or dyskinetic cerebral palsy' and that 'other subtypes of cerebral palsy are less likely.' 24 Our results support this element of the Executive Summary, since the majority (79%) of children with neonatal encephalopathy with suspected birth asphyxia had either a spastic quadriplegia or dyskinetic neurological subtype.…”

Section: Discussionmentioning

confidence: 99%

Cerebral palsy after neonatal encephalopathy: do neonates with suspected asphyxia have worse outcomes?

Garfinkle

Wintermark

Shevell

et al. 2015

Develop Med Child Neuro

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CCPRCanadian Cerebral Palsy Registry REPACQ Registre de la Paralysie C er ebrale au Qu ebec AIM We sought to investigate how brain injury and severity, and neurological subtype of cerebral palsy (CP) differed in term-born children with CP after neonatal encephalopathy, between those with suspected birth asphyxia and those without.METHOD Using the Canadian CP Registry, which included 1001 children, those with CP born at ≥36wks after moderate or severe neonatal encephalopathy, were dichotomized according to the presence or absence of suspected birth asphyxia. Gross Motor Function Classification System (GMFCS) scores, neurological subtypes, comorbidities, and magnetic resonance imaging findings were compared. RESULTS

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“…These include hereditary or acquired thrombophilias and environmental factors that occur before, during, and after delivery (Table 1). However, establishing a causal role for many risk factors awaits larger, more definitive, prospective or case-controlled studies [15]. a. Gestational diabetes: Perinatal stroke in infant of diabetic mother is not uncommon.…”

Section: Unilateral Basal Ganglia Infarction In a Neonate Born To A Mmentioning

confidence: 99%

Unilateral Basal Ganglia Infarctions in a Neonate Born to a Mother with Gestational Diabetes: Case Report

Kentab¹

2016

JNSK

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Cerebral infarcts are an important cause of neonatal convulsions. Perinatal arterial ischemic stroke (PAIS) is a cerebrovascular event occurring during fetal or neonatal life, before 28 days after birth. It has an estimated incidence of one in 2300 to 5000 live births based on the consensus of the National Institute of Neurological Disorders and Stroke [1]. Over 80% of cases involve the middle cerebral artery or its branches [2]. It is an under-recognized cause of significant long -term disabilities, including hemiplegic cerebral palsy, epilepsy, cognitive delays and behavioral impairments [3]. Perinatal BG stroke is uncommon, but the true incidence is unknown. The author report the etiologic factors, clinical and neuroradiologic findings of full term neonate born to a mother with gestational diabetes who presented with right -sided clonicneonatal convulsions and had an isolated unilateral basal ganglia (BG) stroke.

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Symptomatic Neonatal Arterial Ischemic Stroke: The International Pediatric Stroke Study

Abstract: Newborns with AIS are often systemically sick, whereas their mothers are usually healthy. Definitive causes for most neonatal AISs have not been established, and large-scale case-control studies are required to understand pathogenesis if outcomes are to be improved.

Cited by 228 publications

References 26 publications

Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

Cerebral palsy after neonatal encephalopathy: do neonates with suspected asphyxia have worse outcomes?

Unilateral Basal Ganglia Infarctions in a Neonate Born to a Mother with Gestational Diabetes: Case Report

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