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Neonatal arterial ischaemic stroke: obstetric issues

Jeanie L Y Cheong1, Frances M Cowan

  • 1Neonatal Services, Royal Women's Hospital, Melbourne, Australia.

Seminars in Fetal & Neonatal Medicine
|August 18, 2009
PubMed

Insights

Perinatal arterial ischaemic stroke (PAIS) is a significant cause of childhood neurological issues. Identifying diverse risk factors in term and preterm infants is crucial for understanding and preventing PAIS.

Area of Science:

  • Neurology
  • Pediatrics
  • Neonatology

Background:

  • Perinatal arterial ischaemic stroke (PAIS) is a growing concern for pediatric neurological morbidity.
  • The precise causes of PAIS are not fully understood, but some perinatal risk factors have been noted in limited studies.
  • Risk factors for PAIS differ between term and preterm infants.

Purpose of the Study:

  • To identify and differentiate risk factors associated with perinatal arterial ischaemic stroke in term versus preterm infants.
  • To highlight the multifactorial nature of PAIS etiology.

Main Methods:

  • Review of existing case series and literature to identify reported risk factors.
  • Comparison of risk factor profiles between term and preterm infant populations experiencing PAIS.

Main Results:

  • In term infants, risk factors include maternal primiparity, infertility, cocaine use, prothrombotic disorders, prolonged membrane rupture, abnormal cardiotocography, instrumental deliveries, and emergency cesarean sections.
  • Uncomplicated vaginal delivery and prelabor cesarean sections are rarely associated with PAIS.
  • In preterm infants, risk factors identified include fetal heart abnormalities, twin-twin transfusion, and hypoglycemia.
  • The presence of multiple risk factors elevates the likelihood of developing PAIS.

Conclusions:

  • PAIS etiology is complex and multifactorial, with distinct risk profiles for term and preterm neonates.
  • Further large-scale cohort studies are necessary to fully elucidate the pathways leading to perinatal arterial stroke.

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