title: Association between hypoxia and perinatal arterial ischemic stroke: a meta-analysis.
abstract: BACKGROUND
  Perinatal arterial ischemic stroke (AIS) occurs in an estimated 17 to 93 per 100000 live births, yet the etiology is poorly understood. Although investigators have implicated hypoxia as a potential cause of AIS, the role of hypoxia in AIS remains controversial. The aim of this study was to estimate the association between perinatal hypoxia factors and perinatal arterial ischemic stroke through a meta-analysis of published observational studies.
  
  
  METHODS
  A systematic search of electronically available studies published through July 2013 was conducted. Publication bias and heterogeneity across studies were evaluated and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with fixed-effects or random-effects models.
  
  
  RESULTS
  A total of 8 studies describing the association between perinatal hypoxia factors and neonatal arterial ischemic stroke (AIS) met inclusion criteria, and 550 newborns with AIS were enrolled. The associations were found for AIS: preeclampsia (OR 2.14; 95% CI, 1.25 to 3.66), ventouse delivery (OR 2.23; 95% CI, 1.26 to 3.97), fetal heart rate abnormalities (OR 6.30; 95% CI, 3.84 to 10.34), reduced fetal movement (OR 5.35; 95% CI, 2.17 to 13.23), meconium-stained liquor (OR 3.05; 95% CI, 2.02 to 4.60), low Apgar score (OR 5.77; 95% CI, 1.66 to 20.04) and resuscitation at birth (OR 4.59; 95% CI, 3.23 to 6.52). Our data did not show any significant change of the mean risk estimate for oxytocin induction (OR 1.33; 95% CI, 0.84 to 2.11) and low arterial umbilical cord ph (OR 4.63; 95% CI 2.14 to 9.98).
  
  
  CONCLUSIONS
  There is a significant association between perinatal hypoxia factors and AIS. The result indicates that perinatal hypoxia maybe one of causes of AIS. Large scale prospective clinical studies are still warranted.
authors.affiliation: Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China ; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Sichuan, China ; Department of Emergency, West China Second University Hospital, Sichuan University, Sichuan, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Luo
authors.affiliation: Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China.
authors.forename: Dapeng
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China ; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Sichuan, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Qu
authors.affiliation: Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China.
authors.forename: Jinlin
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Emergency, West China Second University Hospital, Sichuan University, Sichuan, China.
authors.forename: Xihong
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China ; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Sichuan, China.
authors.forename: Dezhi
authors.initials: D
authors.lastname: Mu
mesh_terms: D001034:Apgar Score; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000473:pathology*; D005260:Female; D005333:Fetus; D006339:Heart Rate; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000473:pathology*; D007231:Infant, Newborn; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000473:pathology; D011247:Pregnancy; D012307:Risk Factors; D014620:Vacuum Extraction, Obstetrical