Haemorrhagic stroke in term and late preterm neonates

Christie J. Bruno, Lauren A. Beslow, Char M. Witmer, Arastoo Vossough, Lori C. Jordan, Sarah Zelonis, Daniel J. Licht, Rebecca N. Ichord, Sabrina E. Smith

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish (US)
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume99
Issue number1
DOIs
StatePublished - Jan 2014

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Stroke
Newborn Infant
Survivors
Fetal Distress
Outcome Assessment (Health Care)
Apnea
Pediatrics
Neurologic Manifestations
Infarction
Heart Diseases
Seizures
Hemorrhage
Hemostatics
Hydrocephalus
Tertiary Care Centers
Gestational Age
Vomiting
Registries
Pregnancy
Mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Bruno, C. J., Beslow, L. A., Witmer, C. M., Vossough, A., Jordan, L. C., Zelonis, S., ... Smith, S. E. (2014). Haemorrhagic stroke in term and late preterm neonates. Archives of Disease in Childhood: Fetal and Neonatal Edition, 99(1). https://doi.org/10.1136/archdischild-2013-304068

Haemorrhagic stroke in term and late preterm neonates. / Bruno, Christie J.; Beslow, Lauren A.; Witmer, Char M.; Vossough, Arastoo; Jordan, Lori C.; Zelonis, Sarah; Licht, Daniel J.; Ichord, Rebecca N.; Smith, Sabrina E.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 99, No. 1, 01.2014.

Research output: Contribution to journalArticle

Bruno, CJ, Beslow, LA, Witmer, CM, Vossough, A, Jordan, LC, Zelonis, S, Licht, DJ, Ichord, RN & Smith, SE 2014, 'Haemorrhagic stroke in term and late preterm neonates', Archives of Disease in Childhood: Fetal and Neonatal Edition, vol. 99, no. 1. https://doi.org/10.1136/archdischild-2013-304068
Bruno, Christie J. ; Beslow, Lauren A. ; Witmer, Char M. ; Vossough, Arastoo ; Jordan, Lori C. ; Zelonis, Sarah ; Licht, Daniel J. ; Ichord, Rebecca N. ; Smith, Sabrina E. / Haemorrhagic stroke in term and late preterm neonates. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2014 ; Vol. 99, No. 1.
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title = "Haemorrhagic stroke in term and late preterm neonates",
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.",
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AU - Beslow, Lauren A.

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AU - Zelonis, Sarah

AU - Licht, Daniel J.

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N2 - 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.

AB - 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.

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