Association between Hypoxia and Perinatal Arterial Ischemic Stroke: A Meta-Analysis

Graham R Wallace,Xihong Li,Lili Luo,Dapeng Chen,Dezhi Mu,Yi Qu,Jinlin Wu

doi:10.1371/journal.pone.0090106

Abstract

BackgroundPerinatal arterial ischemic stroke (AIS) occurs in an estimated 17 to 93 per 100000 live births, yet the etiology is poorly understood. Although investigators have implicated hypoxia as a potential cause of AIS, the role of hypoxia in AIS remains controversial. The aim of this study was to estimate the association between perinatal hypoxia factors and perinatal arterial ischemic stroke through a meta-analysis of published observational studies.Patients and methodsA systematic search of electronically available studies published through July 2013 was conducted. Publication bias and heterogeneity across studies were evaluated and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with fixed-effects or random-effects models.ResultsA total of 8 studies describing the association between perinatal hypoxia factors and neonatal arterial ischemic stroke (AIS) met inclusion criteria, and 550 newborns with AIS were enrolled. The associations were found for AIS: preeclampsia (OR 2.14; 95% CI, 1.25 to 3.66), ventouse delivery (OR 2.23; 95% CI, 1.26 to 3.97), fetal heart rate abnormalities (OR 6.30; 95% CI, 3.84 to 10.34), reduced fetal movement (OR 5.35; 95% CI, 2.17 to 13.23), meconium-stained liquor (OR 3.05; 95% CI, 2.02 to 4.60), low Apgar score (OR 5.77; 95% CI, 1.66 to 20.04) and resuscitation at birth (OR 4.59; 95% CI, 3.23 to 6.52). Our data did not show any significant change of the mean risk estimate for oxytocin induction (OR 1.33; 95% CI, 0.84 to 2.11) and low arterial umbilical cord ph (OR 4.63; 95% CI 2.14 to 9.98).ConclusionsThere is a significant association between perinatal hypoxia factors and AIS. The result indicates that perinatal hypoxia maybe one of causes of AIS. Large scale prospective clinical studies are still warranted.

Highlights

Neonatal stroke is classified as either ischemic or hemorrhagic stroke, and ischemic stroke is further divided into arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) [1]
A total of 8 studies describing the association between perinatal hypoxia factors and neonatal arterial ischemic stroke (AIS) met inclusion criteria, and 550 newborns with AIS were enrolled
The associations were found for AIS: preeclampsia, ventouse delivery, fetal heart rate abnormalities, reduced fetal movement, meconium-stained liquor, low Apgar score and resuscitation at birth

Summary

Introduction

Neonatal stroke is classified as either ischemic or hemorrhagic stroke, and ischemic stroke is further divided into arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) [1]. Perinatal ischemic stroke (PAIS) is defined as a group of heterogeneous conditions in which there is a focal disruption of cerebral blood flow secondary to arterial or venous thrombosis or embolization [2], which occurred from birth up until 28 days postnatal [3]. Laugesaar reported the incidence rate of neonatal stroke in Estonia was 63 per 100 000 live births in 2007 [5]. A case series of neonates with AIS suggests that newborn boys are at higher risk of ischemic stroke than girls [10,11], with increased frequency in black children [12]. Perinatal arterial ischemic stroke (AIS) occurs in an estimated 17 to 93 per 100000 live births, yet the etiology is poorly understood. The aim of this study was to estimate the association between perinatal hypoxia factors and perinatal arterial ischemic stroke through a meta-analysis of published observational studies

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