Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke
Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke
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DOI：
10.1542/peds.2014-1520
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发表时间：
2015-05-01
期刊：
影响因子：
8
通讯作者：
Steinlin, Maja
中科院分区：
文献类型：
--
作者：
Grunt, Sebastian;Mazenauer, Lea;Steinlin, Maja
背景和目的：新生儿动脉缺血性卒中（NAIS）与相当大的终身负担相关，如脑瘫、癫痫和认知障碍。包括结果评估的前瞻性流行病学研究很少。本研究旨在提供关于流行病学、临床表现、梗死特征、相关临床变量、治疗策略和NAIS在瑞士儿童中的前瞻性、基于人群的队列结果的信息。这项前瞻性研究评价了流行病学、临床表现、血管区域、相关临床变量，2000年至2010年期间在瑞士出生的所有诊断为NAIS的足月新生儿的治疗。随访时间为出生后2年（平均23.3个月，SD 4.3个月）。在此期间，瑞士的NAIS发病率为13例（95%置信区间[CI]，11-17）/100 000例活产。癫痫是最常见的症状（95%）。81%为单侧病变（80%为左侧），19%为双侧病变。风险因素包括产妇风险状况（32%），分娩并发症（68%）和新生儿合并症（54%）。抗血栓和抗血小板治疗的使用率较低（17%）。未报告严重副作用。两年后出生，39%被诊断为脑瘫和31%的智力performance.CONCLUSIONS：NAIS在瑞士显示了类似的发病率作为其他人群为基础的研究。大约三分之一的患者在出生后2年发展为脑瘫或表现出延迟的精神表现，而精神表现正常的儿童在以后的生活中仍然可能出现缺陷。
BACKGROUND AND OBJECTIVES: Neonatal arterial ischemic stroke (NAIS) is associated with considerable lifetime burdens such as cerebral palsy, epilepsy, and cognitive impairment. Prospective epidemiologic studies that include outcome assessments are scarce. This study aimed to provide information on the epidemiology, clinical manifestations, infarct characteristics, associated clinical variables, treatment strategies, and outcomes of NAIS in a prospective, population-based cohort of Swiss children.METHODS: This prospective study evaluated the epidemiology, clinical manifestations, vascular territories, associated clinical variables, and treatment of all full-term neonates diagnosed with NAIS and born in Switzerland between 2000 and 2010. Follow-up was performed 2 years (mean 23.3 months, SD 4.3 months) after birth.RESULTS: One hundred neonates (67 boys) had a diagnosis of NAIS. The NAIS incidence in Switzerland during this time was 13 (95% confidence interval [CI], 11-17) per 100 000 live births. Seizures were the most common symptom (95%). Eighty-one percent had unilateral (80% left-sided) and 19% had bilateral lesions. Risk factors included maternal risk conditions (32%), birth complications (68%), and neonatal comorbidities (54%). Antithrombotic and antiplatelet therapy use was low (17%). No serious side effects were reported. Two years after birth, 39% were diagnosed with cerebral palsy and 31% had delayed mental performance.CONCLUSIONS: NAIS in Switzerland shows a similar incidence as other population-based studies. About one-third of patients developed cerebral palsy or showed delayed mental performance 2 years after birth, and children with normal mental performance may still develop deficits later in life.