Abstract
Objective:To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of the disease.Methods:Clinical data and follow-up results of 33 cases of NCI in neonatal intensive care unit of a first-class hospital from September 2009 to September 2019 were retrospectively analyzed.Results:All 33 patients were diagnosed with NCI by MRI. Among them, 31 cases (93.94%) were full-term infants, 25 cases (75.76%) were mother’s first birth, and 18 (54.55%) cases were males. Pregnancy complications were reported in 18 cases (54.55%), and 19 cases (57.58%) had perinatal hypoxia history. Seizures were the most common first symptom and clinical manifestation in the course of disease (81.8%). There were 27 cases (81.82%) of patent foramen ovale (PFO) among NCI cohort. Ischemic cerebral infarction occurred in 32 cases (96.97%). The middle cerebral artery and its branches were more frequently involved, mainly on the left side. The acute stage of NCI was managed by symptomatic support treatment, and the recovery stage involved mainly rehabilitation treatment. Among the 33 cases, five cases were lost to follow-up, two patients died, 26 patients survived without complications, one case had cerebral palsy, one case had language retardation, and six cases had dyskinesia. Poor prognosis was associated with the involvement of deep gray matter nuclei or multiple lobes, and intrapartum complications. Vaginal mode of delivery and longer hospital stay were associated with better prognosis.Conclusions:Complications leading to placental circulation disorder during pregnancy and perinatal hypoxia are common high-risk factors of NCI. The seizure is the most common clinical manifestation. There is a possible correlation between PFO and NCI. Involvement of deep gray matter or multiple lobes and intrapartum complications may indicate poor prognosis, while vaginal delivery and prolonged hospitalizations are associated with better prognosis of NCI.
Highlights
Neonatal cerebral infarction (NCI), known as neonatal cerebral stroke, refers to the occlusion of one or more branches of neonatal cerebral vessels within 28 days after birth due to various reasons, leading to focal or multifocal ischemic necrosis in the corresponding blood supply area.[1]
As summarized in Table-I, the mean gestational age, mean(±standard deviation (SD)), of 33 hospitalized NCI infants included in the study was 38.52 (±1.42) weeks
Our study showed that intrapartum complications in children with NCI were associated with a poor prognosis
Summary
Neonatal cerebral infarction (NCI), known as neonatal cerebral stroke, refers to the occlusion of one or more branches of neonatal cerebral vessels within 28 days after birth due to various reasons, leading to focal or multifocal ischemic necrosis in the corresponding blood supply area.[1] Cerebral infarction includes arterial ischemic stroke (AIS) and hemorrhagic infarction. AIS is the most common type of cerebral infarction and accounts for about 90% of all the NCI cases.[2] It can occur in the anterior, middle and posterior cerebral arteries, with the left middle cerebral artery being. Pak J Med Sci November - December 2021 Vol 37 No 7 www.pjms.org.pk 1800 the most common location.[3] At present, the risk factors of NCI are still unclear, and the clinical manifestations are diverse, making early diagnosis difficult. Recent developments in neuroimaging technology in newborns has allowed to establish that NCI is not uncommon, with the incidence rate of about 1 / 1600-3000,1 markedly higher than the incidence of cerebral infarction in children and similar to the rate in elderly adults.[4,5] In some cases, NCI may leave some sequelae such as dyskinesia, cognitive impairment, cerebral palsy and epilepsy that have a significant negative impact on the quality of life as well as financial burden to the healthcare system.[6,7,8] In the recent study, the clinical data and prognosis of 33 cases of NCI in a first class hospital were retrospectively analyzed to provide clinical research data for further understanding the characteristics of NCI
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