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Perinatal Stroke in Children With Motor Impairment: A Population-Based Study

Yvonne W. Wu, MD, MPH^*,, Whitney M. March^*, Lisa A. Croen, PhD, Judith K. Grether, PhD^||, Gabriel J. Escobar, MD and Thomas B. Newman, MD, MPH^,¶

^* Department of Neurology, University of California, San Francisco, California
Department of Pediatrics, University of California, San Francisco, California
Kaiser Permanente Division of Research, Oakland, California
^|| California Department of Health Services, Environmental Health Investigations Branch, Oakland, California
^¶ Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Objective. Risk factors for perinatal arterial stroke (PAS) are poorly understood. Most previous studies lack an appropriate control group and include only infants with symptoms in the newborn period. We set out to determine prenatal and perinatal risk factors for PAS.

Methods. In a population-based, case-control study nested within the cohort of 231 582 singleton infants who were born at 36 weeks’ gestation in Northern California Kaiser hospitals from 1991 to 1998, we searched electronically for children with motor impairment and reviewed their medical records to identify diagnoses of PAS. Control subjects were randomly selected from the study population. A medical record abstractor reviewed delivery records without knowledge of case status.

Results. The prevalence of PAS with motor impairment was 17/100 000 live births. Of 38 cases, 26 (68%) presented after 3 months of age with hemiparesis or seizures. All 12 newborns with acute stroke symptoms had seizures. A delayed presentation was more common in children with moderate to severe motor impairment than among infants with only mild motor abnormalities (24 of 31 vs 2 of 7). Prepartum risk factors significantly associated with PAS in multivariate analysis were preeclampsia (odds ratio [OR]: 3.6; 95% confidence interval [CI]: 1.1–11.4) and intrauterine growth restriction (OR: 5.3; 95% CI: 1.5–18.6). Newborns with PAS were also at higher risk of delivery complications, such as emergency cesarean section (OR: 6.8; 95% CI: 2.7–16.6), 5-minute Apgar <7 (OR: 23.6; 95% CI: 4.1–237), and resuscitation at birth (OR: 4.5; 95% CI: 1.6–12.3).

Conclusions. Preeclampsia and intrauterine growth restriction (IUGR) may be independent risk factors for perinatal stroke resulting in motor impairment. Large multicenter studies that include all children with perinatal stroke are needed to determine further the risk factors and outcome of perinatal stroke.

Key Words: perinatal stroke • epidemiology • neonate • infarction • cerebral palsy

Abbreviations: PAS, perinatal arterial stroke • KPMCP, Kaiser Permanente Medical Care Program • ICD-9-CM, International Classification of Diseases, Ninth Revision–Clinical Modification • MRI, magnetic resonance imaging • CT, computed tomography • OR, odds ratio • CI, confidence interval • IUGR, intrauterine growth restriction

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