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Epidemiology and pathogenesis of stroke in preterm infants: A systematic review

B Roy1,2,3, K Walker1,4,5, C Morgan1,6

  • 1Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

Journal of Neonatal-Perinatal Medicine
|July 5, 2021
PubMed

Insights

Perinatal stroke is a major cause of cerebral palsy in preterm infants. This review highlights limited data on causes and pathways, emphasizing clinical suspicion and ultrasound for diagnosis.

Area of Science:

  • Neonatal Neurology
  • Pediatric Stroke
  • Neurodevelopmental Disorders

Background:

  • Perinatal stroke is a leading cause of cerebral palsy (CP) in preterm infants.
  • Stroke mechanisms in preterm infants differ from term infants due to immature brain development.
  • This review focuses on the epidemiology and pathogenesis of three main types: periventricular hemorrhagic infarction (PVHI), perinatal arterial ischemic stroke (PAIS), and cerebral sinovenous thrombosis (CSVT).

Purpose of the Study:

  • To systematically review the epidemiology and pathogenesis of PVHI, PAIS, and CSVT in preterm infants.
  • To explore the distinct characteristics of stroke in preterm neonates.

Main Methods:

  • A systematic review of studies published between 2000 and 2019.
  • Data were sourced from MEDLINE, EMBASE, SCOPUS, and WEB OF SCIENCE databases.
  • Descriptive statistics were used to synthesize findings from 14 included studies.

Main Results:

  • The review analyzed 546 stroke cases in preterm infants (23-36 weeks gestational age).
  • PVHI accounted for 80% of cases, PAIS for 17%, and CSVT for 3%.
  • Specific patterns emerged: parietal PVHI, left MCA PAIS, and transverse sinus CSVT were most common. Data on risk factors were discordant.

Conclusions:

  • There is a significant lack of data on the precise etiology and causal pathways of stroke in preterm infants.
  • Preterm infants with stroke typically do not present with seizures, unlike term infants.
  • A high index of clinical suspicion and routine cranial ultrasound (cUS) are crucial for early diagnosis and understanding stroke in this population.
Abstract

Keywords:
Arterial ischemic strokecerebral sinovenous thrombosisperiventricular hemorrhagic infarction

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