Haemorrhagic stroke in term and late preterm neonates

Abstract

Objective Few data regarding causes and outcome of hemorrhagic stroke (HS) in term neonates are available. We characterized risk factors, mechanism, and short-term outcomes in term and late preterm neonates with acute HS. Design Prospective cohort. Setting Single-center tertiary care stroke registry. Subjects Term and late preterm neonates (≥34 weeks gestation) born 2004-2010 with acute HS ≤28 days of life were identified, and clinical information was abstracted. Short-term outcomes were assessed via standardized neurological exam and rated using the Pediatric Stroke Outcome Measure (PSOM). Results Among 42 subjects, median gestational age was 39.7 weeks [interquartile range (IQR) 38-40.7 weeks]. Diagnosis occurred at a median of 1 day (IQR 0-7 days) after delivery. Twenty-seven (64%) had both intraparenchymal and intraventricular hemorrhage. Mechanism was hemorrhagic transformation of venous or arterial infarction in 22 (53%). Major risk factors included congenital heart disease (CHD), fetal distress, and hemostatic abnormalities. Common presentations included seizure, apnea, and poor feeding or vomiting. Acute hydrocephalus was common. Mortality was 12%. Follow-up occurred in 36/37 survivors at a median of 1 year (IQR 0.5-2.0). Among 17/36 survivors evaluated in stroke clinic, 47% demonstrated neurologic deficits. Deficits were mild (PSOM 0.5-1.5) in 9/36 (25%), and moderate-to-severe (PSOM ≥ 2.0) in 8/36 (22%). Conclusions In our cohort with acute HS, most presented with seizures, apnea, and/or poor feeding. Fetal distress and CHD were common. Nearly two-thirds had intraparenchymal with intraventricular hemorrhage. Over half were due to hemorrhagic transformation of infarction. Short-term neurologic deficits were present in 47% of survivors.

The incidence of severe intraventricular hemorrhage based on retrospective analysis of 35939 full-term newborns—report of two cases and review of literature

“…The bleedings with higher grades originated more often from choroid plexus [3, 5]. Some arteriovenous malformations (AVM) may cause neonatal intracranial hemorrhage.…”

“…IVH may be followed by development of venous sinus, medullary, or cortical vein thrombosis [7]. In one third of cases, a hemorrhage mechanism cannot be determined from neuroimaging studies [5]. Multifocal intraparenchymal hemorrhage was found in the first reported case and choroid plexus hemorrhage in the second patient.…”

“…IVH bleeding in the full-term newborn may occur as a result of birth asphyxia and resuscitation at birth [3, 5, 8, 9]. A significant clinical problem, which is generally regarded as one of the risk factors of IVH, is asphyxia, a secondary consequence to an interruption of placental blood flow and decreased blood flow to the brain and impairment of cerebral autoregulation.…”

Cerebral venous circulatory disturbance as an informative prognostic marker for neonatal hemorrhagic stroke

“…[6][7][8][9][10] In stress-induced model, the small venous hemorrhages in newborn rats develop in the cortex and the subcortical area with the latent time, which is 24 h. Thus, the stress-induced cortical hemorrhages in newborn animals are close to localization, type and original time of NHS.…”

Blood-brain barrier and cerebral blood flow: Age differences in hemorrhagic stroke

“…[1][2][3] The cerebral venous disturbances are one of the important mechanism underlying pathological changes in the CBF associated with the stroke. [23][24][25] It is also known that neonatal stroke is primary the venous infarction 30,31 due to a weakness in the wall of cerebral veins in neonates. 32 Taking into account of these facts, we analyzed the changes in hemodynamic parameters of the sagittal sinus as a main venous sinus of the brain collecting blood from the all cerebral veins.…”