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Transient Middle Cerebral Artery Occlusion Model of Neonatal Stroke in P10 Rats
Published on: April 21, 2017
Neonatal stroke: Clinical characteristics and neurodevelopmental outcomes
Marwa M Elgendy1, Subhash Puthuraya1, Carmela LoPiccolo1
1Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA.
Insights
Neonatal stroke often affects term infants and can lead to seizures. At two years, about one-fifth of infants experienced developmental delays, with significant rates of epilepsy, cerebral palsy, and need for rehabilitation therapies.
Area of Science:
- Neurology
- Pediatrics
- Neonatal care
Background:
- Neonatal stroke can cause lasting neurological issues.
- Limited data exists on neurodevelopmental outcomes and rehabilitation needs in the first two years post-stroke.
- Understanding these outcomes is crucial for early intervention.
Purpose of the Study:
- To characterize clinical features of neonatal stroke.
- To evaluate diagnostic findings including placental pathology and prothrombotic factors.
- To describe neurodevelopmental outcomes, epilepsy, cerebral palsy, and rehabilitation needs at two years.
Main Methods:
- Retrospective cohort study of 55 infants with neonatal stroke (2011-2020).
- Analysis of maternal/infant characteristics, placental pathology, echocardiograms, and prothrombotic evaluations.
- Neurodevelopmental assessment using Bayley Scale of Infant Development (BSID III) at two years.
Main Results:
- Most neonates were term/late preterm, presenting with seizures; lesions were typically unilateral and arterial.
- Commonly associated conditions included maternal chorioamnionitis and perinatal hypoxic-ischemic encephalopathy (HIE).
- At two years, 27% had epilepsy, 16% cerebral palsy, and 18-24% required rehabilitation therapies.
Conclusions:
- Neonatal stroke frequently occurs in term infants, often presenting with seizures and arterial lesions.
- A significant proportion of infants experience developmental delays, epilepsy, cerebral palsy, and require rehabilitation by age two.
- Early identification and intervention are vital for managing long-term sequelae of neonatal stroke.
Background:
Neonatal stroke can potentially result in significant neurological sequelae in affected infants. Studies on neurodevelopmental outcomes and the need for rehabilitation therapies in the first two years are limited. We aimed to describe the clinical characteristics, diagnostic evaluation, and neurodevelopmental outcomes of a cohort of infants with neonatal stroke.
Methods:
A retrospective cohort study of infants with neonatal stroke, from 2011 to 2020. Maternal and infant characteristics were described. Placental pathology, echocardiogram results, and prothrombotic evaluations were reported. The neurodevelopmental outcomes using Bayley scale of infant development (BSID III), rates of epilepsy and cerebral palsy, and the need for rehabilitation therapies at two years were described.
Results:
During the study period, 55 infants had neonatal stroke. Majority (93%) were term or late preterm infants. Maternal chorioamnionitis and perinatal HIE were diagnosed in about a third of the infants. Most (66%) of the infants presented with seizures. On brain MRI, the lesions were unilateral in 76% and arterial in origin in 86% of the infants. Meconium exposure (42%), intrauterine inflammation/infection (37%) and fetal vascular malperfusion (16%) were seen on placental histopathology. At two-year BSID III assessment, median (min, max) composite cognitive, language, and motor scores were 100 (55-145), 97 (47-124), and 100 (46-141), respectively. Among this cohort, epilepsy (27%), cerebral palsy (16%) and the need for rehabilitation therapies (physical -24%, occupational -18%, speech -21%) were reported at two years.
Conclusion:
Neonatal stroke presented commonly in term or late preterm infants with seizures. It was unilateral and arterial in origin in most infants. Maternal chorioamnionitis and perinatal HIE were the most commonly associated conditions at birth. About one-fifth of the infants had mild or severe developmental delays at two years. Epilepsy, cerebral palsy, and need for rehabilitation therapies were noted in a significant proportion of infants at two years.
