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Risk factors for perinatal arterial ischaemic stroke in full-term infants: a case-control study
  1. Johanna C Harteman1,
  2. Floris Groenendaal1,
  3. Anneke Kwee2,
  4. Paco MJ Welsing3,
  5. Manon JNL Benders1,
  6. Linda S de Vries1
  1. 1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
  2. 2Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Utrecht, The Netherlands
  3. 3Julius Centre for Health Sciences and Primary Care and Department of Rheumatology & Clinical Immunology, University Medical Centre, Utrecht, Utrecht, The Netherlands
  1. Correspondence to Linda S de Vries, Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands; L.S.deVries{at}


Objective The incidence of perinatal arterial ischaemic stroke (PAIS) is about 1 in 2300 live births. Evidence about the aetiology is still lacking. The aim of this study was to identify maternal, perinatal and neonatal risk factors for symptomatic PAIS in full-term infants.

Methods Each full-term infant with PAIS was matched to three healthy controls for gestational age, date of birth and hospital of birth. Antenatal and perinatal risk factors were studied using univariate and multivariate conditional logistic regression analysis.

Results Fifty-two infants were diagnosed with PAIS. Significant risk factors in the univariate analysis (p<0.05) were nulliparity (64% vs 47%), maternal fever (>38°C) during delivery (10% vs 1%), fetal heart rate decelerations (63% vs 16%), meconium-stained amniotic fluid (44% vs 17%), emergency caesarean section (35 vs 2%), Apgar score (1 min) ≤3 (29% vs 1%), Apgar score (5 min) <7 (25% vs 1%), umbilical artery pH <7.10 (56% vs 10%), hypoglycaemia <2.0 mmol/l (29% vs 3%) and early-onset sepsis/meningitis (14% vs 2%). In the multivariate analysis, maternal fever (OR 10.2; 95% CI 1.3 to 78.5), Apgar score (5 min) <7 (OR 18.1; 95% CI 3.4 to 96.8), hypoglycaemia <2.0 mmol/l (OR 13.0; 95% CI 3.2 to 52.6) and early-onset sepsis/meningitis (OR 5.8; 95% CI 1.1 to 31.9) were significantly associated with PAIS.

Conclusions Maternal fever during delivery and early-onset sepsis/meningitis were found to be involved with PAIS as was previously noted. Apgar score (5 min) <7 and hypoglycaemia were found to be important risk factors in term PAIS.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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