Maternal and Infant Characteristics Associated With Perinatal Arterial Stroke in the Preterm Infant

Abstract

Background and Purpose-Most perinatal arterial stroke (PAS) studies that investigated infant characteristics have excluded preterm infants from the study population. We sought to analyze the imaging findings and antenatal and perinatal risk factors in preterm infants with PAS. Methods-This was a hospital-based, case-control study of preterm infants. Case infants were confirmed by reviewing brain imaging scans and medical records (nϭ31). Three controls per case were individually matched with case infants from the study population. Results-Gestational age ranged between 27 and 36 weeks, and birth weight ranged between 580 and 3180 g. PAS was more common on the left side (61%), and 7% had bilateral PAS. The majority of strokes involved the middle cerebral artery distribution. Involvement of 1 or more lenticulostriate branches was most common among infants with a gestational age of 28 to 32 weeks, but main branch involvement was seen only in those with a gestational age of Ͼ32 weeks. Twin-to-twin-transfusion syndrome, fetal heart rate abnormality, and hypoglycemia were identified as independent risk factors for PAS. Conclusions-Preterm PAS is associated with prenatal, perinatal, and postpartum risk factors. We were unable to identify any maternal risk factors. Involvement of the different branches of the middle cerebral artery changed with an increase in gestational age.

Lipopolysaccharide-Induced Preconditioning Against Ischemic Injury Is Associated With Changes in Toll-Like Receptor 4 Expression in the Rat Developing Brain

“…3). Preterm infants are known to be at high risk of HI injury (20). Therefore, we investigated the efficacy of LPS protection in P3 and P5 rat pups.…”

Very Early Arterial Ischemic Stroke in Premature Infants

“…However, we did not have matched controls. Benders and colleagues [8] also found that fetal heart rate abnormality and hypoglycemia were risk factor for perinatal stroke in premature neonataes. We know that 6 children in our cohort had fetal distress, and 2 had hypoglycemia in the neonatal intensive care unit.…”

“…We did have 6 children with meningitis, which has been described as a risk factor for stroke in term neonates [13,14]. Although prothrombotic risk factors have been described as a risk factor for stroke in term neonates [15], few of the infants in Benders' cohort [8] or ours received full prothrombotic workups, probably because they were unstable in the neonatal intensive care unit for prolonged periods and often had anemia from multiple blood draws required for ongoing care.…”

“…[6,7] A group in the Netherlands did look at perinatal stroke in premature infants, but there were some interesting differences in their cohort. Benders and colleagues [8] used ultrasound to identify their 31 preterm infants with perinatal stroke. All of their patients were 27 weeks gestational age at birth or older; we had 6 children under 27 weeks gestational age at birth.…”

“…Benders and colleagues [8] found 8 pairs of twins (26%) in their cohort of premature infants with perinatal arterial stroke, and found that 6 were part of monozygous twin pairs with associated twin-twin transfusion syndrome. They compared the children with stroke with matched controls, and found that twin-twin transfusion syndrome was an independent risk factor for perinatal stroke.…”