Perinatal Arterial Ischemic Stroke in Preterm and Term Born Infants: A National Capture- Recapture Calculation Corrected Surveillance Study

Abstract

Background: We aimed to determine nationwide incidence for perinatal arterial ischemic stroke (PAIS) in term and preterm born newborns and to investigate differences in clinical presentation related to gestational age. Methods: This three-year nationwide surveillance study (2015–2017) estimated incidences for MRI confirmed PAIS diagnosed within the first 28 days of life in term and preterm infants. To correct for underreporting we performed capture-recapture-calculations in one federal state and extrapolated nationwide. Differences in clinical presentation in term and preterm born infants were assessed. Findings: 145 infants were reported of whom 19 were born prematurely. CRC corrected incidence for PAIS was 22·0 per 100,000 live births and 31·9 per 100,000 in preterm born infants (p=0·001). 13 (9%) MRI confirmed PAIS cases were classified as asymptomatic. In symptomatic cases, the incidence estimates did not differ between preterm and term born infants. No differences in risk factors were identified but number of risk factors in premature babies was elevated (mean 3·8 versus 2·9; p=0·01). Median age at diagnosis was increased in preterm born infants (7·9 days versus 3·6 days; p=0·04). Clinical seizures were observed in 88% of term born infants with symptoms compared to 33% in premature infants (p<0·0001). Interpretation: Incidence rates of PAIS in Germany were in the range of other population-based studies suggesting similar rates for PAIS in developed countries. New finding is that symptomatic PAIS in preterm born infants is as common as in term born infants. The detection, however, requires awareness of the specific symptom patterns in preterm born infants. Detection of MRI confirmed PAIS in asymptomatic preterm born infants prompted by suspicious ultrasound findings may hint to a hitherto poorly recognized pathway to disability in preterm born infants. Funding Statement: The sponsor was not involved in any aspect pertinent to the study. Declaration of Interests: All authors stated that they had no interests, which might be perceived as posing a conflict or bias. As well, they all disclose prior publication and submission of the manuscript. Ethical Approval Statement: Due to anonymous reporting in ESPED parental consent was not required. Ethical approval was obtained by the ethics committee of the Medical Faculty of the Ludwig-Maximilians-University, Munich, Germany, Nr 42-15 (05-04-2015).