Distinguishing Arterial Ischemic Stroke From Hypoxic-Ischemic Encephalopathy in the Neonate at Birth.
Distinguishing Arterial Ischemic Stroke From Hypoxic-Ischemic Encephalopathy in the Neonate at Birth.
复制标题
DOI：
10.1097/aog.0000000000001631
复制
发表时间：
2016-10
影响因子：
7.2
通讯作者：
Graham EM
中科院分区：
文献类型：
--
作者：
Adami RR;Grundy ME;Poretti A;Felling RJ;Lemmon M;Graham EM
确定围产期的危险因素，可以区分动脉缺血性卒中和新生儿缺氧缺血性脑病。这是一项队列研究，研究对象为2010年1月1日至2015年12月31日期间入住新生儿重症监护室的所有妊娠35周或以上出生的新生儿，比较了脑卒中新生儿和缺氧缺血性脑病新生儿，这些新生儿接受全身低温治疗，并伴有异常脑磁共振成像。在这6年的时间里，有22名中风新生儿和47名缺氧缺血性脑病新生儿接受了全身低温治疗，并出现了异常的磁共振成像。三名被分流到低温治疗的新生儿最初被认为患有缺氧缺血性脑病，后来被诊断为中风。所有卒中新生儿的血栓形成倾向检查均为阴性。单变量分析显示，脑卒中新生儿的癫痫发作发生率显著较高，初始血小板计数增加。在出生后6小时内，单变量分析中P<0.1的变量的多变量模型发现，不可靠的胎心率描记、哨兵事件、5分钟时的低Apgar评分和出生时代谢性酸中毒伴缺氧缺血性脑病显著增加。卒中与初始血小板计数显著增加相关。卒中与初始血小板计数增加相关，与因胎儿心率描记不可靠、哨兵事件或围产期代谢性酸中毒而剖宫产无关。中风是新生儿脑损伤的一种形式，与允许早期识别的围产期风险因素无关。
To identify perinatal risk factors that can distinguish arterial ischemic stroke from hypoxic–ischemic encephalopathy at birth. This is a cohort study of all neonates born at 35 weeks of gestation or greater admitted to our neonatal intensive care unit from January 1, 2010, to December 31, 2015, that compares neonates with stroke with those with hypoxic–ischemic encephalopathy undergoing whole-body hypothermia with abnormal brain magnetic resonance imaging. During this 6-year period, there were 22 neonates with stroke and 47 with hypoxic–ischemic encephalopathy undergoing whole-body hypothermia with abnormal magnetic resonance imaging. Three neonates triaged to hypothermia initially thought to have hypoxic–ischemic encephalopathy were later diagnosed with stroke. All neonates with stroke had a negative thrombophilia workup. Neonates with stroke had a significantly higher incidence of seizures and increased initial platelet counts on univariate analysis. A multivariable model of variables with P<.1 on univariate analysis present within 6 hours of birth found significant increases in nonreassuring fetal heart rate tracings, sentinel events, low Apgar score at 5 minutes, and metabolic acidosis at birth with hypoxic–ischemic encephalopathy. Stroke was associated with a significantly increased initial platelet count. Stroke is associated with increased initial platelet counts and is not associated with cesarean delivery for nonreassuring fetal heart rate tracings, sentinel events, or perinatal metabolic acidosis. Stroke is a form of neonatal brain injury not associated with perinatal risk factors that allow early identification.