title: Risk Factors for Neonatal Arterial Ischemic Stroke: The Importance of the Intrapartum Period.
abstract: To investigate risk factors for neonatal arterial ischemic stroke (NAIS), and compare them with those present in term controls and infants with hypoxic-ischemic encephalopathy (HIE).
  
  
  
  Antepartum and intrapartum data were collected at presentation from 79 infants with NAIS and compared with 239 controls and 405 infants with HIE. The relationships between risk factors and NAIS were explored using univariable and multivariable regression.
  
  
  
  Compared with controls, infants with NAIS more frequently had a family history of seizures/neurologic diseases, primiparous mothers, and male sex. Mothers of infants with NAIS experienced more intrapartum complications: prolonged rupture of membranes (21% vs 2%), fever (14% vs 3%), thick meconium (25% vs 7%), prolonged second stage (31% vs 13%), tight nuchal cord (15% vs 6%), and abnorm8al cardiotocography (67% vs 21%). Male sex (OR 2.8), family history of seizures (OR 6.5) or neurologic diseases (OR 4.9), and ≥1 (OR 5.8) and ≥2 (OR 21.8) intrapartum complications were independently associated with NAIS. Infants with NAIS and HIE experienced similar rates though different patterns of intrapartum complications. Maternal fever, prolonged rupture of membranes, prolonged second stage, tight nuchal cord, and failed ventouse delivery were more common in NAIS; thick meconium, sentinel events, and shoulder dystocia were more frequent in HIE. Abnormal cardiotocography occurred in 67% of NAIS and 77.5% of infants with HIE. One infant with NAIS and no infant with HIE was delivered by elective cesarean (10% of controls).
  
  
  
  NAIS is multifactorial in origin and shares risk factors in common with HIE. Intrapartum events may play a more significant role in the pathogenesis of NAIS than previously recognized.
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom. Electronic address: miriam.mbiarge@imperial.ac.uk.
authors.forename: Miriam
authors.initials: M
authors.lastname: Martinez-Biarge
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom; Departments of Newborn Research and Neonatal Services, Royal Women's Hospital, Melbourne, Australia.
authors.forename: Jeanie L Y
authors.initials: JL
authors.lastname: Cheong
authors.affiliation: Biostatistics Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Diez-Sebastian
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom; Pediatric Neurology Unit, Catholic University, Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Mercuri
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom.
authors.forename: Lilly M S
authors.initials: LM
authors.lastname: Dubowitz
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D015148:Cardiotocography; D016022:Case-Control Studies; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D005334:Fever / Q000453:epidemiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology; D007231:Infant, Newborn; D020244:Infarction, Middle Cerebral Artery / Q000453:epidemiology*; D007748:Labor Stage, Second; D008137:Longitudinal Studies; D008297:Male; D008470:Meconium; D053589:Nuchal Cord / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000150:complications; D012737:Sex Factors
keywords: neonatal MRI; neonatal hypoxic-ischemic encephalopathy; perinatal asphyxia; perinatal brain injury; perinatal cerebral infarction; term infant