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Published on: April 21, 2017
Reevaluating isolated central apnea in early-term and term newborns: A neurological red flag for perinatal stroke
Andrea Calandrino1, Marcella Battaglini1, Samuele Caruggi1
1Neonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.
Introduction:
Seizures are the most frequent initial symptom of perinatal stroke. Apnea, a less commonly recognized neurological presentation, is a cessation of breathing lasting >15 s or shorter if associated with bradycardia. This study explores a monocentric cohort of newborns with perinatal stroke, emphasizing the role of Isolated Central Apnea (ICA) as a potential early indicator of cerebrovascular insult.
Methods:
A retrospective review was conducted on newborns (≥36 weeks GA) diagnosed with MRI-confirmed perinatal stroke at our institution between March 2019 and March 2024. Infants with hypoxic-ischemic encephalopathy (HIE), congenital infections, meningoencephalitis, sepsis, or intrauterine stroke were excluded. Clinical data, neuroimaging findings, EEG/aEEG characteristics, and antiepileptic drug (AED) were analyzed.
Results:
Of 421 newborns who underwent brain MRI, 27 (6 %) were diagnosed with perinatal stroke (16 males; median GA 38.5 weeks; mean BW 3137g). Seizures were the presenting symptom in 18 cases (67 %), while 8 cases (30 %) exhibited ICA as the first sign and an MRI revealing 5 arterial strokes (63 %) and 3 venous strokes (37 %). EEG abnormalities were detected in 7/8 (88 %) cases, while brain ultrasound was abnormal in 5/8 (63 %). AED therapy was required in 7/8 (88 %) patients.
Conclusions:
ICA is an early sign of neonatal stroke in approximately one-third of cases. These findings underscore the importance of brain MRI in the diagnostic workup of persistent apnea in term and early-term neonates.
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