The Incidence and Characteristics of Perinatal Stroke in Beijing: A Multicenter Study

Abstract

ObjectiveTo assess the incidence, risk factors, and clinical characteristics of perinatal stroke in Beijing.MethodsThis multicenter prospective study included all the live births from 17 representative maternal delivery hospitals in Beijing from March 1, 2019 to February 29, 2020. Neonates with a stroke were assigned to the study group. Clinical data, including general information, clinical manifestations, and risk factors, were collected. Up until 18 months after birth, neonates were routinely assessed according to the Ages and Stages Questionnaire (ASQ) and/or the Bayley scale. Statistical analysis was done using the chi-squared, t-tests, and logistic regression analysis using SPSS version 26.0.OutcomesIn total, 27 cases were identified and the incidence of perinatal stroke in Beijing was 1/2,660 live births, including 1/5,985 for ischemic stroke and 1/4,788 for hemorrhagic stroke. Seventeen cases (62.96%) of acute symptomatic stroke and convulsions within 72 h (10 cases, 37.04%) were the most common presentations. Ten patients showed no neurological symptoms and were found to have had a stroke through routine cranial ultrasonography after being hospitalized for non-neurological diseases. The risk factors include primiparity, placental or uterine abruption/acute chorioamnionitis, intrauterine distress, asphyxia, and severe infection. In the study group, 11.1% (3/27) of patients had adverse neurodevelopmental outcomes. The patients in the study group had lower scores for the ASQ than those in the control group in the communication, gross, and fine motor dimensions.ConclusionThe incidence of perinatal stroke in Beijing was consistent with that in other countries. Routine neuroimaging of infants with risk factors may enable identification of asymptomatic strokes in more patients. Patients who have suffered from a stroke may have neurological sequelae; therefore, early detection, treatment, and regular follow-ups are beneficial for improving their recovery outcomes.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…226 A multicenter prospective study in Beijing included all the live births from 17 representative maternal delivery hospitals from March 1, 2019, to February 29, 2020. 227 A total of 27 cases were identified, and the incidence of perinatal stroke in Beijing was 1 in 2660 live births, including 1 in 5985 for ischemic stroke and 1 in 4788 for hemorrhagic stroke.…”

“…A multicenter prospective study in Beijing that included all the live births from 17 representative maternal delivery hospitals from March 1, 2019, to February 29, 2020, found that the risk factors include primiparity, placental or uterine abruption/acute chorioamnionitis, intrauterine distress, asphyxia, and severe infection. 227…”

Placental pathologic lesions associated with stroke in term neonates

“…Recent studies have focused on identifying inflammatory biomarker signatures in patients at-risk for perinatal stroke ( 41 ), which may improve the ability to detect perinatal stroke early and allow initiation of supportive therapies sooner. Some experts have recommended more widespread use of neuroimaging in neonates with risk factors for stroke ( 42 ), but clear algorithms are still lacking to define which neonates are at highest risk. Placental pathology may provide input into a stroke risk stratification algorithm, but the timeframe required for placental examination will be a limiting factor until new techniques are developed that can offer real-time, clinically-relevant information.…”

Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke

“…The incidence of perinatal stroke is estimated as high as one per 1100 live births [2], but lower rates have been reported [3][4][5][6]. Most estimates are based on small samples over short periods of time, with variable ascertainment methods.…”

“…Infants with stroke typically present with seizures or other diffuse neurologic deficits. Some infants with stroke are not identified acutely, but are diagnosed retrospectively, when neurologic symptoms, such as emerging hemiparesis or seizures, leads to neuroimaging [ 5 ]. In contrast, children with stroke typically present with focal neurologic deficits, usually hemiplegia and/or focal seizures.…”