REVIEW   

Minerva Pediatrics 2023 May 31

DOI: 10.23736/S2724-5276.23.07301-9

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Clinical profiles of acute arterial ischemic neonatal stroke

Mario MASTRANGELO ¹, Rossella BOVE ¹, Giacomina RICCIARDI ¹, Laura GIORDO ¹, Paola PAPOFF ², Emanuela TURCO ³, Maria LUCENTE ⁴, Francesco PISANI ¹ *

¹ Child Neurology and PsychiatryUnit, Department of Human Neurosciences, Sapienza University, Rome, Italy; ² Pediatric Intensive Care Unit, Department of Maternal-Infantile and Urological Sciences, Sapienza University, Rome, Italy; ³ Unit of Child Neurology and Psychiatry, University of Parma, Parma, Italy; ⁴ Neonatal Intensive Care Unit, Pugliese Ciaccio Hospital, Catanzaro, Italy

INTRODUCTION: Perinatal stroke includes a heterogeneous group of early focal neurological injuries affecting subsequent brain development, often resulting in motor sequelae, symptomatic epilepsies, and cognitive, language and behavioral impairment. The incidence of perinatal stroke is about 1/3500 live birth.
EVIDENCE ACQUISITION: A PubMed and SCOPUS search strategy included the entries “neonatal ischemic stroke” OR “perinatal ischemic stroke” and the age of the filter under 18 years and January 2000-August 2022.
EVIDENCE SYNTHESIS: The cumulative literature analysis highlighted 3880 published patients (from 98 articles) with stroke, mainly presenting with clinical or electro-graphical seizures (2083 patients). The mean age at presentation was 2,5±2,4 days (data available for 1182 patients). Stroke occurred in the first week of life in 1164 newborns. The mainly involved ischemic areas were within the territories of the middle cerebral artery (1403 patients). Predisposing risk factors included fetal/newborn factors (1908 patients), dystocial birth (759 patients), maternal (678 patients), and placental factors (63 patients). No thrombolysis and/or endovascular treatments were performed, while data about other pharmacological treatments were restricted to a single article. The death occurred in 29 newborns. Motor, neurocognitive and language impairment were cumulatively reported in 875 patients. Epileptic seizures during the follow-up were reported in 238 cases.
CONCLUSIONS: The literature analysis highlighted that every term newborn presenting with acute neurological signs and symptoms during the first week of life should always be considered for the identification of an ischemic stroke.

KEY WORDS: Stroke; Infant, newborn; Child