Perinatal Stroke in Australian Children

Abstract

Background:More than half of all strokes in children occur during the perinatal period, with a global incidence of 25–40 per 100,000 live births. Aetiology is unclear, hampering prevention research. Diagnosis is often delayed, hindering intervention: first, because some risk factors are present in healthy infants, making at-risk differentiation difficult; second, because variable clinical presentations exist. The aims were to determine Australian birth prevalence, scrutinise risk factors, analyse clinical characteristics and outcomes.

Methods: Six studies were conducted. First, a systematic review examined the placental risk factors for perinatal stroke and second, a retrospective audit ascertained placental histopathology in neonatal practices. Third, a systematic review examined prematurity as a risk factor. Fourth study analysed aetiology; fifth study assessed prevalence; and sixth study examined outcomes of perinatal stroke from a longitudinal prospective population-based case- controlled study.

Results: Estimated birth prevalence of perinatal stroke in Australia was 9.6 cases per 100,000 live births per year. Independent risk factors were smoke exposure during pregnancy, 10-minute Apgar score <7, neonatal infection, and hypoglycaemia. Additional risk factors were emergency caesarean section, resuscitation at birth, and abnormal cord blood gas. Conclusive assumptions about the placenta were not possible, given the low frequencies of examination, inconsistent reporting, and the contribution of prematurity. However, thromboinflammatory placental changes were associated with perinatal stroke. Interestingly, 35% presented with pure respiratory symptoms including tachypnoea, apnoea, and cyanosis.

Conclusions: This perinatal stroke research identified rates, independent risk factors, clinical profiles and outcomes, with 48% having neurological impairment. A high index of clinical suspicion and prospective collaborative studies are needed to identify high-risk infants.