Risk factors for neonatal arterial ischemic stroke: The importance of the intrapartum period

Eugenio Maria Mercuri, Miriam Martinez-Biarge, Jeanie L.Y. Cheong, Jesus Diez-Sebastian, Lilly M.S. Dubowitz, Frances M. Cowan

Risultato della ricerca: Contributo in rivistaArticolo in rivista

36 Citazioni (Scopus)

Abstract

Objective To investigate risk factors for neonatal arterial ischemic stroke (NAIS), and compare them with those present in term controls and infants with hypoxic-ischemic encephalopathy (HIE). Study design Antepartum and intrapartum data were collected at presentation from 79 infants with NAIS and compared with 239 controls and 405 infants with HIE. The relationships between risk factors and NAIS were explored using univariable and multivariable regression. Results Compared with controls, infants with NAIS more frequently had a family history of seizures/neurologic diseases, primiparous mothers, and male sex. Mothers of infants with NAIS experienced more intrapartum complications: prolonged rupture of membranes (21% vs 2%), fever (14% vs 3%), thick meconium (25% vs 7%), prolonged second stage (31% vs 13%), tight nuchal cord (15% vs 6%), and abnorm8al cardiotocography (67% vs 21%). Male sex (OR 2.8), family history of seizures (OR 6.5) or neurologic diseases (OR 4.9), and ≥1 (OR 5.8) and ≥2 (OR 21.8) intrapartum complications were independently associated with NAIS. Infants with NAIS and HIE experienced similar rates though different patterns of intrapartum complications. Maternal fever, prolonged rupture of membranes, prolonged second stage, tight nuchal cord, and failed ventouse delivery were more common in NAIS; thick meconium, sentinel events, and shoulder dystocia were more frequent in HIE. Abnormal cardiotocography occurred in 67% of NAIS and 77.5% of infants with HIE. One infant with NAIS and no infant with HIE was delivered by elective cesarean (10% of controls). Conclusions NAIS is multifactorial in origin and shares risk factors in common with HIE. Intrapartum events may play a more significant role in the pathogenesis of NAIS than previously recognized.
Lingua originaleEnglish
pagine (da-a)62-68.e1
RivistaJournal of Pediatrics
Volume173
DOI
Stato di pubblicazionePubblicato - 2016

Keywords

  • Pediatrics, Perinatology and Child Health
  • neonatal MRI
  • neonatal hypoxic-ischemic encephalopathy
  • perinatal asphyxia
  • perinatal brain injury
  • perinatal cerebral infarction
  • term infant

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