Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Pediatrics

25-04-2024 | Stroke | Research

Risk factors of neonatal stroke from different origins: a systematic review and meta-analysis

Authors: Yankun Song, Shangbin Li, Ling Hao, Yiwei Han, Wenhui Wu, Yuqing Fan, Xiong Gao, Xueying Li, Changjun Ren, Yuan Chen

Published in: European Journal of Pediatrics

Login to get access

Abstract

Given the persistent ambiguity regarding the etiology of neonatal stroke across diverse origins, our objective was to conduct a comprehensive evaluation of both qualitative and quantitative risk factors. An exhaustive search of eight databases was executed to amass all pertinent observational studies concerning risk factors for neonatal stroke from various origins. Subsequent to independent screening, data extraction, and bias assessment by two researchers, a meta-analysis was conducted utilizing RevMan and Stata software. Nineteen studies, encompassing a total of 30 factors, were incorporated into this analysis. Beyond established risk factors, our investigation unveiled gestational diabetes (OR, 5.51; P < 0.00001), a history of infertility (OR, 2.44; P < 0.05), placenta previa (OR, 3.92; P = 0.02), postdates (OR, 2.07; P = 0.01), preterm labor (OR, 2.32; P < 0.00001), premature rupture of membranes (OR, 3.02; P = 0.007), a prolonged second stage of labor (OR, 3.94; P < 0.00001), and chorioamnionitis (OR, 4.35; P < 0.00001) as potential risk factors for neonatal cerebral arterial ischemic stroke. Additionally, postdates (OR, 4.31; P = 0.003), preterm labor (OR, 1.60; P < 0.00001), an abnormal CTG tracing (OR, 9.32; P < 0.0001), cesarean section (OR, 4.29; P = 0.0004), male gender (OR, 1.73; P = 0.02), and vaginal delivery (OR, 1.39; P < 0.00001) were associated with an elevated risk for neonatal hemorrhagic stroke.
Conclusions: This study provides a succinct overview and comparative analysis of maternal, perinatal, and additional risk factors associated with neonatal cerebral artery ischemic stroke and neonatal hemorrhagic stroke, furnishing critical insights for healthcare practitioners involved in the diagnosis and prevention of neonatal stroke. This research also broadens the conceptual framework for future investigations.
What is Known:
• Research indicates that prenatal, perinatal, and neonatal risk factors can elevate the risk of neonatal arterial ischemic stroke (NAIS). However, the risk factors for neonatal cerebral arterial ischemic stroke remain contentious, and those for neonatal hemorrhagic stroke (NHS) and neonatal cerebral venous sinus thrombosis (CVST) are still not well-defined.
What is New:
• This study is the inaugural comprehensive review and meta-analysis encompassing 19 studies that explore maternal, perinatal, and various risk factors linked to neonatal stroke of differing etiologies. Notably, our analysis elucidates eight risk factors associated with NAIS: gestational diabetes mellitus, a history of infertility, placenta previa, postdates, preterm birth, premature rupture of membranes, a prolonged second stage of labor, and chorioamnionitis. Furthermore, we identify six risk factors correlated with NHS: postdates, preterm birth, an abnormal CTG, the method of delivery, male gender, and vaginal delivery. Additionally, our systematic review delineates risk factors associated with CVST.
Appendix
Available only for authorised users
Literature
1.
Greenham M et al (2021) Fatigue following pediatric arterial ischemic stroke. Stroke 52(10):3286–3295PubMedCrossRef
2.
Ferriero DM, Fullerton HJ, Bernard TJ et al (2019) Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association[J]. Stroke 50(3):e51–e96PubMedCrossRef
3.
Li C et al (2017) Prenatal, perinatal and neonatal risk factors for perinatal arterial ischaemic stroke: a systematic review and meta-analysis. Eur J Neurol 24(8):1006–1015PubMedCrossRef
4.
5.
Christensen R et al (2022) Cerebral venous sinus thrombosis in preterm infants. Stroke 53(7):2241–2248PubMedCrossRef
6.
Rutherford MA, Ramenghi LA, Cowan FM (2012) Neonatal stroke. Archives Disease Child - Fetal Neonatal Ed 97(5):F377–F384CrossRef
7.
Elgendy MM, Cortez J (2023) Contralateral massive neonatal arterial ischemic stroke secondary to carotid artery dissection: A case report[J]. Cureus 15(11)
8.
Wu YW et al (2004) Perinatal stroke in children with motor impairment: a population-based study. Pediatrics 114(3):612–619PubMedCrossRef
9.
Lee J, Croen LA, Backstrand KH et al (2005) Maternal and infant characteristics associated with perinatal arterial stroke in the infant[J]. Jama 293(6):723–729PubMedCrossRef
10.
Benders MJNL et al (2007) Maternal and infant characteristics associated with perinatal arterial stroke in the preterm infant. Stroke 38(6):1759–1765PubMedCrossRef
11.
Armstrong-Wells J et al (2009) Prevalence and predictors of perinatal hemorrhagic stroke: results from the Kaiser Pediatric Stroke Study. Pediatrics 123(3):823–828PubMedCrossRef
12.
Tan M et al (2011) Sagittal sinus compression is associated with neonatal cerebral sinovenous thrombosis. Pediatrics 128(2):e429–e435PubMedCrossRef
13.
Estan J, Hope P (1997) Unilateral neonatal cerebral infarction in full term infants[J]. Archives Disease Child Fetal Neonatal Ed 76(2):F88CrossRef
14.
Tuckuviene R et al (2012) Infant, obstetrical and maternal characteristics associated with thromboembolism in infancy: a nationwide population-based case-control study. Archives Disease Child - Fetal Neonatal Ed 97(6):F417–F422CrossRef
15.
Harteman JC et al (2012) Risk factors for perinatal arterial ischaemic stroke in full-term infants: a case-control study. Archives Disease Child - Fetal Neonatal Ed 97(6):F411–F416CrossRef
16.
Chunling Huang et al (2012) A risk factor for neonatal cerebral infarction. Chin J Perinat Med 15(6):337–344
17.
Adami RR et al (2016) Distinguishing arterial ischemic stroke from hypoxic–ischemic encephalopathy in the neonate at birth. Obstet Gynecol 128(4):704–712PubMedPubMedCentralCrossRef
18.
Martinez–Biarge M (2016) Risk factors for neonatal arterial ischemic stroke: the importance of the intrapartum period. J Pediatr 173:62-68e1PubMedCrossRef
19.
Cole L, Dewey D, Letourneau N et al (2017) Clinical characteristics, risk factors, and outcomes associated with neonatal hemorrhagic stroke: a population-based case-control study[J]. JAMA Pediatr 171(3):230–238PubMedCrossRef
20.
Arnaez J et al (2017) Neonatal arterial ischemic stroke: risk related to family history, maternal diseases, and Genetic Thrombophilia. Clin Appl Thromb Hemost 24(1):79–84PubMedPubMedCentralCrossRef
21.
Sorg AL et al (2019) Risk factors for perinatal arterial ischaemic stroke: a large case–control study. Dev Med Child Neurol 62(4):513–520PubMedCrossRef
22.
Yeo KT et al (2020) Improving incidence trends of severe intraventricular haemorrhages in preterm infants < 32 weeks gestation: a cohort study. Archives Disease Child - Fetal Neonatal Ed 105(2):145–150CrossRef
23.
Sorg A-L et al (2021) Clinical diversity of cerebral sinovenous thrombosis and arterial ischaemic stroke in the neonate: a surveillance study. Neonatology 118(5):530–536PubMedCrossRef
24.
Xia Q, Xie Y, Yang Z et al (2022) The incidence and characteristics of perinatal stroke in Beijing: A multicenter study[J]. Frontiers in Public Health 10:783153PubMedPubMedCentralCrossRef
25.
Srivastava R, Dunbar M, Shevell M et al (2022) Development and validation of a prediction model for perinatal arterial ischemic stroke in term neonates[J]. JAMA Netw Open 5(6):e2219203–e2219203PubMedPubMedCentralCrossRef
26.
Liang R et al (2023) 45 clinical features and risk factors of neonatal cerebral infarction. Chin J Perinat Med 26(1):53–58
27.
Berfelo FJ et al (2010) Neonatal cerebral sinovenous thrombosis from symptom to outcome. Stroke 41(7):1382–1388PubMedCrossRef
28.
Sorg AL et al (2021) Incidence and risk factors of cerebral sinovenous thrombosis in infants. Dev Med Child Neurol 63(6):697–704PubMedCrossRef
29.
Fitzgerald KC, Williams LS, Garg BP et al (2006) Cerebral sinovenous thrombosis in the neonate[J]. Arch Neurol 63(3):405–409PubMedCrossRef
30.
Nwosu ME et al (2008) Neonatal sinovenous thrombosis: presentation and association with imaging. Pediatr Neurol 39(3):155–161PubMedCrossRef
31.
Chappell LC et al (2019) Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 394(10204):1181–1190PubMedPubMedCentralCrossRef
32.
Giraud A, Guiraut C, Chevin M et al (2017) Role of perinatal inflammation in neonatal arterial ischemic stroke[J]. Front Neurol 8:303768CrossRef
33.
Guiraut C, Cauchon N, Lepage M et al (2016) Perinatal arterial ischemic stroke is associated to materno-fetal immune activation and intracranial arteritis[J]. Int J Mol Sci 17(12):1980PubMedPubMedCentralCrossRef
34.
Caglayan EK, Caglayan K, Erdogan N et al (2014) Preventing intraperitoneal adhesions with ethyl pyruvate and hyaluronic acid/carboxymethylcellulose: A comparative study in an experimental model[J]. Eur J Obstet Gynecol Reprod Biol 181:1–5PubMedCrossRef
35.
Casey JA et al (2016) Using Electronic Health Records for Population Health Research: a review of methods and applications. Annu Rev Public Health 37(1):61–81PubMedCrossRef
36.
Lambicchi L et al (2021) Different antecedents and neonatal condition in neonatal arterial ischemic stroke and hypoxic-ischemic neonatal encephalopathy. Int J Gynecol Obstet 157(2):333–339CrossRef
37.
Fraser S et al (2023) A National, Electronic Health Record–based study of perinatal hemorrhagic and ischemic stroke. J Child Neurol 38(3–4):206–215PubMedPubMedCentralCrossRef
38.
van der Aa NE, Benders MJNL, Vincken KL et al (2013) The course of apparent diffusion coefficient values following perinatal arterial ischemic stroke[J]. PLoS One 8(2):e56784PubMedPubMedCentralCrossRef
39.
Bruno CJ et al (2014) Haemorrhagic stroke in term and late preterm neonates. Archives Disease Child - Fetal Neonatal Ed 99(1):F48–F53CrossRef
40.
41.
Roy B, Webb A, Walker K et al (2023) Prevalence & risk factors for perinatal stroke: A population-based study[J]. Child Neurol Open 10:2329048X231217691PubMedPubMedCentralCrossRef
42.
Dlamini N, Billinghurst L, Kirkham FJ (2010) Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin North Am 21(3):511–527CrossRef
43.
Kersbergen KJ et al (2009) Anticoagulation therapy and imaging in neonates with a unilateral thalamic hemorrhage due to cerebral sinovenous thrombosis. Stroke 40(8):2754–2760PubMedCrossRef
44.
Ferro JM, Aguiar de Sousa D (2019) Cerebral venous thrombosis: An update[J]. Curr Neurol Neurosci Rep 19:1–9CrossRef
Metadata
Title
Risk factors of neonatal stroke from different origins: a systematic review and meta-analysis
Authors
Yankun Song
Shangbin Li
Ling Hao
Yiwei Han
Wenhui Wu
Yuqing Fan
Xiong Gao
Xueying Li
Changjun Ren
Yuan Chen
Publication date
25-04-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-024-05531-5