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Haemorrhagic stroke in term and late preterm neonates
  1. Christie J Bruno1,
  2. Lauren A Beslow2,
  3. Char M Witmer3,
  4. Arastoo Vossough4,
  5. Lori C Jordan5,
  6. Sarah Zelonis6,
  7. Daniel J Licht6,
  8. Rebecca N Ichord6,
  9. Sabrina E Smith6,7
  1. 1Division of Neonatal-Perinatal Medicine, The Children's Hospital at Montefiore, Albert Einstein School of Medicine, Bronx, New York, USA
  2. 2Departments of Pediatrics and Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3Division of Hematology, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4Division of Neuroradiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5Division of Child Neurology and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  6. 6Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
  7. 7Division of Pediatric Neurology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
  1. Correspondence to Christie J Bruno, The Children's Hospital at Montefiore, 1601 Tenbroeck Avenue, 2nd Floor, Bronx, NY 10461, USA; cbruno{at}montefiore.org

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.

  • Neonatal
  • Hemorrhagic Stroke

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