Risk Factors for Perinatal Arterial Ischemic Stroke

Abstract

Introduction:Arterial ischemic stroke in newborns is an important cause of neonatal morbidity and mortality. Its pathophysiology and associated risk factors are not yet clearly understood and defined.Objective:The aim of this retrospective study was to investigate possible risk factors in diagnosed cases of PAIS (perinatal arterial ischemic stroke).Materials and methods:Case–control study. Clinical data of patients with PAIS diagnosis were analyzed. Two healthy controls were selected for each PAIS case, matched for gestational age. Risk factors were explored using univariable and multivariable analysis.Outcome:40 patients were included in the study, 24 males and 16 females; 52.5% of cases were diagnosed within the first month of birth, and 47.5% were retrospectively diagnosed. The results showed a male predominance (66.7%). The distribution of cerebral ischemic injury was predominantly medial cerebral artery (87.5%) and occurred more commonly in the left cerebral hemisphere (62.5%). Significant risk factors in the univariate analysis (P < 0.05) were primiparity, stillbirth, neonatal sepsis, asphyxia, twin pregnancy, placenta abruption, emergency cesarean section, Apgar score ≤7 after 5 min, breech presentation, and hyperbilirubinemia. In the multivariate analysis, primiparity (OR 11.74; CI 3.28–42.02), emergency cesarean section (OR 13.79; CI 3.51–54.13), birth asphyxia (OR 40.55; CI 3.08–532.94) and Apgar score ≤7 after 5 min (OR 13.75; CI 1.03–364.03) were significantly associated factors with PAIS. Only five (16.6%) patients had an abnormal thrombophilia study.Conclusion:Risk factors of primiparity, emergency cesarean section, birth asphyxia, and Apgar score ≤7 after 5 min were significantly associated with perinatal stroke. More studies with a larger number of patients and with prolonged follow up are required to establish more clearly the associated risk factors involved in this pathology.

Pediatric Acute Ischemic Stroke by Age-Group: A Systematic Review and Meta-Analysis of Published Studies and Hospitalization Records

“…Risk factors associated with neonatal AIS, including biologic or environmental factors pertaining to the mother, her pregnancy, the delivery of the newborn, or neonatal comorbidities may account for the high and variable rates of AIS during the neonatal period [24,28]. Specific maternal and pregnancy-related factors that have been associated with neonatal AIS include, but are not limited to, pre-eclampsia, prolonged rupture of membranes, and infection [29].…”

Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia

“…Risk factors associated with neonatal stroke, including biological or environmental factors relating to the mother, pregnancy, delivery, or neonatal comorbidities, may account for high and variable rates of AIS ( Table 2 ). 11 , 12 The etiologies of childhood and adolescent stroke are diverse and include, but are not limited to, cardiac causes, arteriopathies (intracranial or extracranial), vasculitis and autoimmune disorders (eg, systemic lupus erythematosus), hematologic disorders (eg, SCD), and traumatic injury. 12 , 13 Contrary to our expectations, parental history of stroke or consanguinity did not significantly contribute to the incidence of strokes in our study.…”

Perinatal Stroke; Risk Factors and Outcome. A Study from Aga Khan University Hospital Karachi

“…10 Although several risk factors have been identified, many questions regarding causes and clinical outcomes remain unanswered. [11][12] The identified risk factors including maternal, neonatal and placental conditions, but most of them are with a focus on specific conditions and do not necessarily reflect a causal relation. In this study, several maternal conditions were taken as risk factors such as intrauterine infections, autoimmune diseases (antiphospholipid syndrome), gestational diabetes and preeclampsia, while infertility treatment, hypothyroidism, and vitamin D deficiency were also found in few cases.…”