Neonatal Stroke Active Surveillance Study in the United Kingdom and Ireland with meta-analysis of surveillance studies

Read the full article See related articles

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

This article is not in any list yet, why not save it to one of your lists.
Log in to save this article

Abstract

Background

Neonatal stroke is a rare but devastating condition. This study explored the incidence, clinical presentation, management and short-term outcomes of neonatal stroke across five countries in the United Kingdom (UK) and Republic of Ireland (ROI) in the post-COVID-19 era.

Methods

This active surveillance study identified neonatal stroke cases presenting before 90 days of life between March 2022-April 2023 in the UK and ROI using the monthly British Paediatric Surveillance Unit (BPSU) reporting system. Reporting clinicians completed questionnaires and uploaded de-identified neuroimages via a purpose-built data platform. A meta-analysis of neonatal stroke active surveillance studies was performed.

Results

68 neonatal stroke cases were reported. UK incidence of neonatal stroke was 9·0 per 100,000 live births (95% CI 6·9-11·6). Three-quarters of the cases were arterial ischaemic and unilateral. Arterial ischaemic and cerebral venous sinus thrombosis (CVST) strokes commonly presented with seizures at two-three days of age, while haemorrhagic stroke commonly presented with encephalopathy in the first ten days of age. Neonatal stroke cases were associated with fetal distress in utero . 61% and 28% of infants had an umbilical cord pH <7·25 and required significant resuscitation at birth, respectively. A meta-analysis of 3,607,864 infants found the incidence and associated conditions were similar to pre-COVID-19 surveillance studies in Germany and Australia.

Neonatal stroke guidelines were available in a quarter of the reporting hospitals. 87% of infants with arterial ischaemic and CVST stroke received antiseizure medications. 82% of infants were discharged home at a median of 12 days old with antiseizure medications (42%) alongside paediatric/neonatal (91%), physiotherapy (77%) and paediatric neurology (63%) follow-up.

Conclusions

Neonatal stroke is a rare disease with distinct subtypes associated with different clinical presentations, timings and management strategies, highlighting the need to better understand this condition. The incidence pre- and post-COVID-19 appeared similar.

Funding

2019 BPSU Sir Peter Tizard Award

Article activity feed