Outcome Trajectories after Primary Perinatal Hemorrhagic Stroke.

Authors

Giulia S Porcari
Lori C Jordan
Rebecca N Ichord
Daniel J Licht
Sabrina E Smith
Lauren A Beslow

Publication/Presentation Date

4-1-2020

Abstract

BACKGROUND: Perinatal hemorrhagic stroke in late preterm and term neonates is understudied. We describe two-month and two-year neurological outcomes in a prospective cohort.

METHODS: Neonates ≥36 weeks' gestation with spontaneous hemorrhagic stroke (parenchymal and intraventricular) presenting at age ≤28 days were enrolled between March 2007 and May 2015 at three tertiary pediatric centers. Hemorrhagic transformation of arterial ischemic stroke or cerebral sinovenous thrombosis was excluded. The Pediatric Stroke Outcome Measure (PSOM) assessed outcomes. Wilcoxon signed-rank tests evaluated change over time.

RESULTS: Twenty-six neonates were included (median age: 1 day, interquartile range [IQR] 0 to 16; median gestational age: 38.3 weeks, IQR 37.0 to 39.0). Hemorrhage was isolated intraventricular in seven (27%), isolated intraparenchymal in six (23%), and a combination in 10 (39%). Three neonates (12%) died during hospitalization; one died later due to cardiac disease. Among 22 survivors, outcomes were assessed at a median of 2.1 months (IQR 1.7 to 3.3) in 96% and 1.9 years (IQR 1.3 to 2.0) in 73%. Median PSOM scores were 0.0 (IQR 0.0 to 1.0) and 0.25 (IQR 0.0 to 1.3), respectively. At two years, 45% of patients had no or nonimpairing deficits (PSOM < 1.0), 30% had mild deficits (PSOM 1.0 to 2.0), and 5% had moderate deficits (PSOM 2.5 to 4.5). Over time, 31% worsened and 6% improved. Although total PSOM scores did not change significantly (P = 0.08), language subscores worsened (P = 0.009). No child developed epilepsy.

CONCLUSIONS: Perinatal hemorrhagic stroke survivors had favorable outcomes in early childhood; at two years moderate to severe deficits occurred in 5%. Language deficits may emerge over time, warranting close follow-up.

Volume

105

First Page

41

Last Page

47

ISSN

1873-5150

Published In/Presented At

Porcari, G. S., Jordan, L. C., Ichord, R. N., Licht, D. J., Smith, S. E., & Beslow, L. A. (2020). Outcome Trajectories after Primary Perinatal Hemorrhagic Stroke. Pediatric neurology, 105, 41–47. https://doi.org/10.1016/j.pediatrneurol.2019.11.019

Disciplines

Medicine and Health Sciences | Pediatrics

PubMedID

31952959

Department(s)

Department of Pediatrics

Document Type

Article