Obstetrical and neonatal characteristics vary with birthweight in a cohort of 100 term newborns with symptomatic arterial ischemic stroke.
OBJECTIVE
Many questions remain regarding the mechanism of perinatal stroke.


METHODS
In a series of 100 prospectively enrolled term neonates with symptomatic arterial ischemic stroke, we explored family antecedents, pregnancy and delivery conditions and clinical presenting features and distinguished features of the 50 larger infants with the remainder. Cardiac and cervical arterial imaging were performed in 70 and 51 cases.


RESULTS
Previous fetal loss, first pregnancy, primiparity, twin-gestation, cesarean and traumatic delivery, neonatal distress, male sex and premature rupture of membranes were statistically more common than in the general population. Normal pregnancy proportion and mean birthweight were in the normal range, arguing against a vasculo-placental origin in the majority. Furthermore, there was an excess of large babies. The larger infants were more subject to suffer from acute perinatal events, with a trend for an excess of neonatal distress (p=0.065) and for more severe presenting features (p=0.027), while the lighter were more likely to have experienced longstanding obstetrical risk factors such as complicated pregnancy (p=0.047) and tobacco exposure (p=0.028). Cervical MR angiography showed an internal carotid occlusion in two babies, whereas echo-Doppler was always normal; in one case the two methods were discordant. Echocardiography was non-informative.


CONCLUSIONS
The data from this prospective cohort of neonates with stroke confirm that many obstetrical and perinatal factors are risk determinants. They also suggest that birthweight and gender may be biomarkers of two populations of neonates with different pathological mechanisms. MR angiography appears more sensitive than echo-Doppler for the exploration of the neonatal cervical vasculature.
Chabrier
Stéphane
S
Unit of Néonatologie et Réanimation Pédiatrique, Centre Hospitalier Universitaire, 42055 Saint-Etienne, France. stephane.chabrier@chu-st-etienne.fr
Saliba
Elie
E
Nguyen The Tich
Sylvie
S
Charollais
Aude
A
Varlet
Marie-Noëlle
MN
Tardy
Brigitte
B
Presles
Emilie
E
Renaud
Cyrille
C
Allard
Dominique
D
Husson
Béatrice
B
Landrieu
Pierre
P
D001238:Asphyxia Neonatorum / Q000453:epidemiology; D015415:Biomarkers; D001724:Birth Weight / Q000502:physiology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D014463:Ultrasonography
D015415:Biomarkers