title: Haemorrhagic stroke in term and late preterm neonates.
abstract: OBJECTIVE
  Few data regarding causes and outcomes of haemorrhagic stroke (HS) in term neonates are available. We characterised risk factors, mechanism and short-term outcomes in term and late preterm neonates with acute HS.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Single-centre tertiary care stroke registry.
  
  
  METHODS
  Term and late preterm neonates (≥ 34 weeks gestation), born 2004-2010, with acute HS ≤ 28 days of life were identified, and clinical information was abstracted. Short-term outcomes were assessed via standardised neurological exam and rated using the Paediatric Stroke Outcome Measure (PSOM).
  
  
  RESULTS
  Among 42 neonates, median gestational age was 39.7 weeks (IQR 38-40.7 weeks). Diagnosis occurred at a median of 1 day (IQR 0-7 days) after delivery. Twenty-seven (64%) had intraparenchymal and intraventricular haemorrhage. Mechanism was haemorrhagic transformation of venous or arterial infarction in 22 (53%). Major risk factors included congenital heart disease (CHD), fetal distress and haemostatic abnormalities. Common presentations included seizure, apnoea, and poor feeding or vomiting. Acute hydrocephalus was common. Mortality was 12%. Follow-up occurred in 36/37 survivors at a median of 1 year (IQR 0.5-2.0 years). Among 17/36 survivors evaluated in stroke clinic, 47% demonstrated neurologic deficits. Deficits were mild (PSOM 0.5-1.5) in 9/36 (25%), and moderate-to-severe (PSOM ≥ 2.0) in 8/36 (22%).
  
  
  CONCLUSIONS
  In our cohort with acute HS, most presented with seizures, apnoea and/or poor feeding. Fetal distress and CHD were common. Nearly two-thirds had intraparenchymal with intraventricular haemorrhage. Over half were due to haemorrhagic transformation of infarction. Short-term neurologic deficits were present in 47% of survivors.
authors.affiliation: Division of Neonatal-Perinatal Medicine, The Children's Hospital at Montefiore, Albert Einstein School of Medicine, , Bronx, New York, USA.
authors.forename: Christie J
authors.initials: CJ
authors.lastname: Bruno
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.forename: Char M
authors.initials: CM
authors.lastname: Witmer
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.forename: Lori C
authors.initials: LC
authors.lastname: Jordan
authors.forename: Sarah
authors.initials: S
authors.lastname: Zelonis
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
authors.forename: Sabrina E
authors.initials: SE
authors.lastname: Smith
mesh_terms: D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D007902:Length of Stay; D018810:Magnetic Resonance Angiography; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate
keywords: Hemorrhagic Stroke; Neonatal