Haemorrhagic stroke in term and late preterm neonates.
Publication/Presentation Date
1-1-2014
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.
DESIGN: Prospective cohort.
SETTING: Single-centre tertiary care stroke registry.
SUBJECTS: 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.
Volume
99
Issue
1
First Page
48
Last Page
53
ISSN
1468-2052
Published In/Presented At
Bruno, C. J., Beslow, L. A., Witmer, C. M., Vossough, A., Jordan, L. C., Zelonis, S., Licht, D. J., Ichord, R. N., & Smith, S. E. (2014). Haemorrhagic stroke in term and late preterm neonates. Archives of disease in childhood. Fetal and neonatal edition, 99(1), F48–F53. https://doi.org/10.1136/archdischild-2013-304068
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
23995383
Department(s)
Department of Pediatrics
Document Type
Article