Munoz Daniela, Hidalgo María José, Balut Fernanda, Troncoso Mónica, Lara Susana, Barrios Andrés, Parra Patricia
Department of Pediatric Neurology and Psychiatry, San Borja Arriarán Hospital, University of Chile, Santiago, Chile.
Cell Med. 2018 Jul 11;10:2155179018785341. doi: 10.1177/2155179018785341. eCollection 2018.
Arterial ischemic stroke in newborns is an important cause of neonatal morbidity and mortality. Its pathophysiology and associated risk factors are not yet clearly understood and defined.
The aim of this retrospective study was to investigate possible risk factors in diagnosed cases of PAIS (perinatal arterial ischemic stroke).
Case-control study. Clinical data of patients with PAIS diagnosis were analyzed. Two healthy controls were selected for each PAIS case, matched for gestational age. Risk factors were explored using univariable and multivariable analysis.
40 patients were included in the study, 24 males and 16 females; 52.5% of cases were diagnosed within the first month of birth, and 47.5% were retrospectively diagnosed. The results showed a male predominance (66.7%). The distribution of cerebral ischemic injury was predominantly medial cerebral artery (87.5%) and occurred more commonly in the left cerebral hemisphere (62.5%). Significant risk factors in the univariate analysis (P < 0.05) were primiparity, stillbirth, neonatal sepsis, asphyxia, twin pregnancy, placenta abruption, emergency cesarean section, Apgar score ≤7 after 5 min, breech presentation, and hyperbilirubinemia. In the multivariate analysis, primiparity (OR 11.74; CI 3.28-42.02), emergency cesarean section (OR 13.79; CI 3.51-54.13), birth asphyxia (OR 40.55; CI 3.08-532.94) and Apgar score ≤7 after 5 min (OR 13.75; CI 1.03-364.03) were significantly associated factors with PAIS. Only five (16.6%) patients had an abnormal thrombophilia study.
Risk factors of primiparity, emergency cesarean section, birth asphyxia, and Apgar score ≤7 after 5 min were significantly associated with perinatal stroke. More studies with a larger number of patients and with prolonged follow up are required to establish more clearly the associated risk factors involved in this pathology.
新生儿动脉缺血性卒中是新生儿发病和死亡的重要原因。其病理生理学及相关危险因素尚未得到明确的认识和界定。
本回顾性研究旨在调查确诊的围产期动脉缺血性卒中（PAIS）病例的可能危险因素。
病例对照研究。分析PAIS诊断患者的临床资料。为每例PAIS病例选择两名健康对照，按孕周匹配。采用单变量和多变量分析探索危险因素。
40例患者纳入研究，男性24例，女性16例；52.5%的病例在出生后第一个月内确诊，47.5%为回顾性诊断。结果显示男性占优势（66.7%）。脑缺血损伤分布主要在大脑中动脉（87.5%），且更常见于左侧大脑半球（62.5%）。单变量分析中的显著危险因素（P<0.05）有初产、死产、新生儿败血症、窒息、双胎妊娠、胎盘早剥、急诊剖宫产、5分钟后阿氏评分≤7、臀位和高胆红素血症。多变量分析中，初产（OR 11.74；CI 3.28 - 42.02）、急诊剖宫产（OR 13.79；CI 3.51 - 54.13）、出生窒息（OR 40.55；CI 3.08 - 532.94）和5分钟后阿氏评分≤7（OR 13.75；CI 1.03 - 364.03）是与PAIS显著相关的因素。只有五例（16.6%）患者有异常的血栓形成倾向研究。
初产、急诊剖宫产、出生窒息和5分钟后阿氏评分≤7等危险因素与围产期卒中显著相关。需要开展更多纳入更多患者并延长随访时间的研究，以更明确地确定该疾病所涉及的相关危险因素。
