Trajectories of outcomes following a primary perinatal hemorrhagic stroke

Author(s): Emma Rio

Background and Objectives: There is a lack of research on perinatal hemorrhagic stroke in term and late preterm infants. Neurological outcomes at two months and two years in a prospective cohort are described.

Methods: Three tertiary pediatric centers took in neonates who were less than 36 weeks pregnant and had a spontaneous parenchymal or intraventricular stroke at less than 28 days of age. Hemorrhagic change of blood vessel ischemic stroke or cerebral sinovenous apoplexy was avoided. The outcomes were evaluated by the Pediatric Stroke Outcome Measure (PSOM). Change over time was evaluated using Wilcoxon signed-rank tests.

Finding: Twenty-six newborns (median age: 1 day, 95% CI 0-16; Age at median gestation: 38.3 weeks, or an IQR of 37.0-39.0). In seven cases, the hemorrhage was isolated intraventricular (27 percent), intraparenchymal (23 percent), or a combination of both. During hospitalization, three newborns (12%) died; one passed away later from heart disease. Results were evaluated at a median of 2.1 months (IQR 1.7-03.3) in 96% of the 22 survivors and 1.9 years (IQR 1.3–2.0) in 73%. The median PSOM scores were, respectively, 0.25 (IQR 0.-1.3) and 0.0 (IQR 0.0-1.0). 45 percent of patients had no or minimal deficits (PSOM 1.0), 30 percent had mild deficits (PSOM 1.0-2.0), and 5 percent had moderate

deficits (PSOM 2.5-4.5) at two years. 31% got worse over time and 6% got better. Language sub-scores got worse (p=0.009), but total PSOM scores didn’t change much (p=0.08). None of the children had epilepsy.

Conclusion: Infantile hemorrhagic stroke survivors experienced favorable early childhood outcomes; 5 percent experienced moderate-severe deficits after two years. Language impairments may develop over time and require close monitoring.