title: Incidence and outcomes of symptomatic neonatal arterial ischemic stroke.
abstract: OBJECTIVE
  Neonatal arterial ischemic stroke (NAIS) is associated with considerable lifetime burdens such as cerebral palsy, epilepsy, and cognitive impairment. Prospective epidemiologic studies that include outcome assessments are scarce. This study aimed to provide information on the epidemiology, clinical manifestations, infarct characteristics, associated clinical variables, treatment strategies, and outcomes of NAIS in a prospective, population-based cohort of Swiss children.
  
  
  METHODS
  This prospective study evaluated the epidemiology, clinical manifestations, vascular territories, associated clinical variables, and treatment of all full-term neonates diagnosed with NAIS and born in Switzerland between 2000 and 2010. Follow-up was performed 2 years (mean 23.3 months, SD 4.3 months) after birth.
  
  
  RESULTS
  One hundred neonates (67 boys) had a diagnosis of NAIS. The NAIS incidence in Switzerland during this time was 13 (95% confidence interval [CI], 11-17) per 100,000 live births. Seizures were the most common symptom (95%). Eighty-one percent had unilateral (80% left-sided) and 19% had bilateral lesions. Risk factors included maternal risk conditions (32%), birth complications (68%), and neonatal comorbidities (54%). Antithrombotic and antiplatelet therapy use was low (17%). No serious side effects were reported. Two years after birth, 39% were diagnosed with cerebral palsy and 31% had delayed mental performance.
  
  
  CONCLUSIONS
  NAIS in Switzerland shows a similar incidence as other population-based studies. About one-third of patients developed cerebral palsy or showed delayed mental performance 2 years after birth, and children with normal mental performance may still develop deficits later in life.
authors.affiliation: Department of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland; sebastian.grunt@insel.ch.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Grunt
authors.affiliation: Department of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland;
authors.forename: Lea
authors.initials: L
authors.lastname: Mazenauer
authors.affiliation: Department of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland;
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Buerki
authors.affiliation: Department of Neuropaediatrics, University Children's Hospital, Zurich, Switzerland;
authors.forename: Eugen
authors.initials: E
authors.lastname: Boltshauser
authors.affiliation: Department of Neuropaediatrics, Children's Hospital, Aarau, Switzerland;
authors.forename: Andrea Capone
authors.initials: AC
authors.lastname: Mori
authors.affiliation: Department of Neuropaediatrics, University Children's Hospital, Basel, Switzerland;
authors.forename: Alexandre N
authors.initials: AN
authors.lastname: Datta
authors.affiliation: Neuropaediatrics, Paediatric Subspecialties Service, University Children's Hospital, Geneva, Switzerland;
authors.forename: Joël
authors.initials: J
authors.lastname: Fluss
authors.affiliation: Champreveyres 4, Neuchâtel, Switzerland;
authors.forename: Danielle
authors.initials: D
authors.lastname: Mercati
authors.affiliation: Department of Neuropaediatrics, Children's Hospital, Chur, Switzerland;
authors.forename: Elmar
authors.initials: E
authors.lastname: Keller
authors.affiliation: Department of Neuropaediatrics, Children's Hospital, St Gallen, Switzerland;
authors.forename: Oliver
authors.initials: O
authors.lastname: Maier
authors.affiliation: Department of Neuropaediatrics, University Children's Hospital, Lausanne, Switzerland;
authors.forename: Claudia
authors.initials: C
authors.lastname: Poloni
authors.affiliation: Department of Paediatrics, Children's Hospital, Bellinzona, Switzerland; and.
authors.forename: Gian-Paolo
authors.initials: GP
authors.lastname: Ramelli
authors.affiliation: Department of Neuropaediatrics, Children's Hospital, Lucerne, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitt-Mechelke
authors.affiliation: Department of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland;
authors.forename: Maja
authors.initials: M
authors.lastname: Steinlin
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
keywords: cerebral palsy; epidemiology; neonate; outcome; stroke