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Published on: April 21, 2017
Recognition, identification, and diagnosis announcement of neonatal arterial ischemic stroke: A combined exploratory
Cindy Leal Martins1, Stéphane Chabrier2, Joel Fluss1
1Pediatric Neurology Unit, Paediatric subspecialties Service, Geneva University Hospitals, Rue Willy-Donzé 6, 1211 Geneva 14, Switzerland.
Insights
Neonatal arterial ischemic stroke (NAIS) affects 1 in 4258 births, with diagnosis delays often stemming from delayed recognition of early symptoms. Improving caregiver awareness is vital for timely NAIS diagnosis and management.
Area of Science:
- Neurology
- Pediatrics
- Neonatology
Background:
- Neonatal arterial ischemic stroke (NAIS) is a significant cause of neurological impairment in newborns.
- Understanding the epidemiology and care pathways for NAIS is crucial for improving outcomes.
Purpose of the Study:
- To investigate the epidemiology of NAIS and the timeline of care from symptom onset to diagnosis.
- To explore parental experiences with the diagnostic process, including perceived delays, communication, and quality of life.
Main Methods:
- Retrospective analysis of NAIS cases treated at the institution.
- Quantitative data from medical records and qualitative data from semi-structured parental interviews.
Main Results:
- NAIS incidence was 1 in 4258 births; most neonates presented within 48 hours with focal clonus.
- Diagnosis consideration and confirmation averaged 5 and 33 hours, respectively, with delayed symptom recognition as a key factor.
- NAIS caused significant parental emotional distress despite generally good health outcomes.
Conclusions:
- Enhanced awareness of NAIS among maternity caregivers is essential for early diagnosis and neuroprotective strategies.
- Clinicians must be mindful of communication regarding diagnosis and prognosis to mitigate parental stress and misconceptions.
Objectives:
To examine the epidemiology of neonatal arterial ischemic stroke (NAIS) and the chronology of care from early reported manifestations to formal diagnosis obtained by imaging. To explore how parents experienced the sequence of events, their own perception of potential diagnostic delay, diagnosis announcement, and prognosis discussion, and their current view of their child's quality of life.
Methods:
We retrospectively analyzed data of all NAIS cases that have been treated in our institution. Quantitative data came from both newborns' and mothers' medical records. Qualitative data were collected from parents in semi-structured interviews based on a standardized questionnaire composed of open-ended questions.
Results:
A total of 14 neonates were treated for NAIS in our institution between January 2008 and December 2017. The incidence of NAIS during this period was one out of 4258 births. The majority of neonates presented within 48 hours with a mean of 27h after birth, most often in the form of repetitive focal clonus (13/14). The mean time before diagnosis consideration and confirmation was 5 and 33h, respectively. Late consideration of early reported symptoms was identified as the main source of delay. Despite good reported health outcome, NAIS was associated with significant acute and long-standing parental emotional stress.
Conclusion:
Maternity hospital caregivers' awareness of NAIS is crucial to reach early diagnosis. Improving this aspect would not only allow better early management, but also make it possible to set up acute neuroprotective strategies. Clinicians should be attentive to the modalities of diagnosis and prognosis announcements, which are associated with considerable stress and misconceptions.
