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Vojcek E, Jermendy A, Laszlo AM, et al. The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study. Early Hum Dev. 2021;158:105393doi: 10.1016/j.earlhumdev.2021.105393.
Vojcek, E., Jermendy, A., Laszlo, A. M., Graf, R., Rudas, G., Berenyi, M., & Seri, I. (2021). The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study. Early human development, 158105393. https://doi.org/10.1016/j.earlhumdev.2021.105393
Vojcek, Eszter, et al. "The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study." Early human development vol. 158 (2021): 105393. doi: https://doi.org/10.1016/j.earlhumdev.2021.105393
Vojcek E, Jermendy A, Laszlo AM, Graf R, Rudas G, Berenyi M, Seri I. The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study. Early Hum Dev. 2021 Jul;158:105393. doi: 10.1016/j.earlhumdev.2021.105393. Epub 2021 May 17. PMID: 34034089.
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Early Hum Dev. 2021 Jul;158:105393. doi: 10.1016/j.earlhumdev.2021.105393. Epub 2021 May 17.

The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study.

Early human development

Eszter Vojcek, Agnes Jermendy, Anna M Laszlo, Rozsa Graf, Gabor Rudas, Marianne Berenyi, Istvan Seri

Affiliations

  1. First Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Saint John Hospital and North-Buda Unified Hospitals, Budapest, Hungary. Electronic address: [email protected].
  2. First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
  3. Institute of Mathematics and Base Sciences, Szent István University, Budapest, Hungary.
  4. Department of Rehabilitation, Szent János Hospital and North Buda United Hospitals, Budapest, Hungary.
  5. Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
  6. Department of Developmental Neurology, Saint Margaret Hospital, Budapest, Hungary.
  7. First Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, United States.

PMID: 34034089 DOI: 10.1016/j.earlhumdev.2021.105393

Abstract

BACKGROUND: Neonatal arterial ischemic stroke (NAIS) carries the risk of significant long-term neurodevelopmental burden on survivors.

AIMS: To assess the long-term neurodevelopmental outcome of term neonates diagnosed with NAIS and investigate the associations among brain territorial involvement on MRI, clinical risk factors and neurodevelopmental outcomes.

STUDY DESIGN: Population-based cohort study.

SUBJECTS: Seventy-nine term neonates with NAIS confirmed by MRI born between 2007 and 2017.

OUTCOME MEASURES: Long-term neurodevelopmental outcome assessed using the Bayley Scales of Infant Development-II, the Brunet-Lézine test and the Binet Intelligence scales-V.

RESULTS: Follow-up was available in 70 (89%) of the subjects enrolled, at a median age of 60 months [IQR: 35-84]. Normal neurodevelopmental outcome was found in 43% of the patients. In a multivariable model, infants with main MCA stroke had an increased risk for overall adverse outcome (OR: 9.1, 95% CI: 1.7-48.0) and a particularly high risk for cerebral palsy (OR: 55.9, 95% CI: 7.8-399.2). The involvement of the corticospinal tract without extensive stroke also increased the risk for cerebral palsy/fine motor impairment (OR: 13.5, 95% CI: 2.4-76.3). Multiple strokes were associated with epilepsy (OR: 9.5, 95% CI: 1.0-88.9) and behavioral problems (OR: 4.4, 95% CI: 1.1-17.5) and inflammation/infection was associated with cerebral palsy (OR: 9.8, 95% CI: 1.4-66.9), cognitive impairment (OR: 9.2, 95% CI: 1.8-47.8) and epilepsy (OR: 10.3, 95% CI: 1.6-67.9).

CONCLUSIONS: Main MCA stroke, involvement of the corticospinal tract, multiple strokes and inflammation/infection were independent predictors of adverse outcome, suggesting that the interplay of stroke territorial involvement and clinical risk factors influence the outcome of NAIS.

Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Keywords: Corticospinal tract; Infection; Main middle cerebral artery stroke; Multiple strokes; Neonatal arterial ischemic stroke; Neurodevelopmental outcome

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