title: Symptomatic neonatal arterial ischemic stroke: the International Pediatric Stroke Study.
abstract: BACKGROUND
  Neonatal arterial ischemic stroke (AIS) has emerged as a leading cause of perinatal brain injury, cerebral palsy, and lifelong disability. The pathogenesis is poorly understood, which limits the development of treatment and prevention strategies. Multicenter studies must define epidemiology, risk factors, treatment practices, and outcomes to advance clinical trials and improve the adverse outcomes suffered by most survivors.
  
  
  METHODS
  The International Pediatric Stroke Study is a global research initiative of 149 coinvestigators (30 centers in 10 countries). Patients with clinical and neuroimaging confirmation of symptomatic neonatal AIS were enrolled (2003-2007). Standardized, Web-based data entry collected clinical presentations, risk factors, investigations, treatments, and early outcomes. We examined predictors of infarct characteristics and discharge outcome by using multivariate logistic regression.
  
  
  RESULTS
  Two hundred forty-eight neonates were studied (57% male, 10% premature). Most of them presented with seizure (72%) and nonfocal neurologic signs (63%). MRI was completed for 92% of the infants, although <50% had vascular imaging. Infarcts preferentially involved the anterior circulation and left hemisphere and were multifocal in 30%. Maternal health and pregnancies were usually normal. Neonates often required resuscitation (30%) and had systemic illnesses (23%). Cardiac and prothrombotic abnormalities were identified in <20% of the infants. Antithrombotic treatment was uncommon (21%) and varied internationally. Half (49%) of the infants had deficits at discharge, and data on their long-term outcomes are pending.
  
  
  CONCLUSIONS
  Newborns with AIS are often systemically sick, whereas their mothers are usually healthy. Definitive causes for most neonatal AISs have not been established, and large-scale case-control studies are required to understand pathogenesis if outcomes are to be improved.
authors: Alberta Children's Hospital, Calgary, Alberta, Canada. adam.kirton@albertahealthservices.ca
authors: Adam
authors: A
authors: Kirton
authors: Jennifer
authors: J
authors: Armstrong-Wells
authors: Taeun
authors: T
authors: Chang
authors: Gabrielle
authors: G
authors: Deveber
authors: Michael J
authors: MJ
authors: Rivkin
authors: Marta
authors: M
authors: Hernandez
authors: Jessica
authors: J
authors: Carpenter
authors: Jerome Y
authors: JY
authors: Yager
authors: John K
authors: JK
authors: Lynch
authors: Donna M
authors: DM
authors: Ferriero
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy; D002539:Cerebral Arterial Diseases / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy