Predictive value of clinical and EEG features in the diagnosis of stroke and hypoxic ischemic encephalopathy in neonates with seizures.
OBJECTIVE
In neonates, the differentiation of stroke and hypoxic ischemic encephalopathy (HIE) is important. Neuroimaging presents technical challenges in unstable neonates, resulting in frequently delayed or missed diagnosis of stroke. Differentiating clinical and electroencephalographic (EEG) features would assist physicians in the timely diagnosis. We sought to determine, in neonates with seizures, clinical and EEG features that differentiate stroke and HIE.


METHODS
Retrospective cohort study comparing clinical, seizure, and EEG features in term neonates with ischemic stroke or HIE and seizures within 7 days after birth, admitted at The Hospital for Sick Children. Putative clinical and EEG predictors of stroke were analyzed with univariate and multivariate methods.


RESULTS
Sixty-two newborns with stroke (n=27) or HIE (n=35) were studied. With univariate analysis, predictors of stroke included delayed seizure onset (>or=12-hours after birth) (P<0.0001; OR, 26.4; 95% CI, 6.8, 102.5), focal motor seizures (P=0.001; OR, 7.2; 95% CI, 2.0, 26.0) and pattern of neurological abnormalities (P<0.0001). With multivariate analysis, delayed seizure onset (P<0.0001; OR 39.7; 95% CI, 7.3, 217.0) and focal motor seizures (P=0.007; OR, 13.4; 95% CI, 2.1, 87.9) predicted stroke. Presence of both predictors had 100% positive predictive value and specificity, 61% negative predictive value and 37% sensitivity.


CONCLUSIONS
In neonates, onset of seizures beyond 12 hours of birth and clinically observed focal seizures are predictive of stroke. These preinvestigation indicators of stroke may facilitate earlier diagnosis and institution of specific management strategies.
Rafay
Mubeen F
MF
Department of Pediatrics and Child Health, Winnipeg Children's Hospital, University of Manitoba, Winnipeg, MB, Canada. mrafay@exchange.hsc.mb.ca
Cortez
Miguel A
MA
de Veber
Gabrielle A
GA
Tan-Dy
Cherrie
C
Al-Futaisi
Amna
A
Yoon
Woojin
W
Fallah
Shafagh
S
Moore
Aideen M
AM
D015331:Cohort Studies; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology