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2016 ; 128
(4
): 704-712
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Distinguishing Arterial Ischemic Stroke From Hypoxic-Ischemic Encephalopathy in
the Neonate at Birth
#MMPMID27607878
Adami RR
; Grundy ME
; Poretti A
; Felling RJ
; Lemmon M
; Graham EM
Obstet Gynecol
2016[Oct]; 128
(4
): 704-712
PMID27607878
show ga
OBJECTIVE: To identify perinatal risk factors that can distinguish arterial
ischemic stroke from hypoxic-ischemic encephalopathy at birth. METHODS: 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.
RESULTS: 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. CONCLUSION: 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.