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Risk factors for perinatal arterial ischaemic stroke in full-term infants: a case-control study
Johanna C Harteman1, Floris Groenendaal, Anneke Kwee
1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
Insights
Maternal fever during delivery, low Apgar scores, hypoglycemia, and early-onset sepsis are key risk factors for perinatal arterial ischaemic stroke (PAIS) in full-term infants. Identifying these factors is crucial for prevention and timely intervention.
Area of Science:
- Neonatal Neurology
- Perinatal Medicine
- Pediatric Stroke
Background:
- Perinatal arterial ischaemic stroke (PAIS) affects approximately 1 in 2300 live births.
- The precise etiological factors contributing to PAIS remain incompletely understood.
- Identifying risk factors is essential for developing preventative strategies.
Purpose of the Study:
- To investigate maternal, perinatal, and neonatal risk factors associated with symptomatic PAIS in term infants.
- To differentiate significant risk factors through robust statistical analysis.
Main Methods:
- A case-control study design was employed, matching each PAIS infant to three healthy controls.
- Risk factors were assessed using univariate and multivariate conditional logistic regression.
- Data included antenatal, perinatal, and neonatal variables.
Main Results:
- Fifty-two cases of PAIS were identified.
- Univariate analysis revealed associations with maternal fever, fetal heart rate decelerations, meconium staining, emergency C-section, low Apgar scores, umbilical artery acidosis, hypoglycemia, and sepsis.
- Multivariate analysis confirmed maternal fever (OR 10.2), Apgar score <7 (OR 18.1), hypoglycemia <2.0 mmol/l (OR 13.0), and early-onset sepsis/meningitis (OR 5.8) as significant risk factors.
Conclusions:
- Maternal fever during delivery and early-onset sepsis/meningitis are confirmed as contributing factors to PAIS.
- Low Apgar scores (5 min <7) and neonatal hypoglycemia are identified as critical risk factors for term PAIS.
- These findings highlight key targets for intervention and prevention of neonatal stroke.
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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