Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 823-828 (doi:10.1542/peds.2008-0874)

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ARTICLE

Prevalence and Predictors of Perinatal Hemorrhagic Stroke: Results From the Kaiser Pediatric Stroke Study

Jennifer Armstrong-Wells, MD, MPH^a, S. Claiborne Johnston, MD, PhD^a,b, Yvonne W. Wu, MD, MPH^a,c, Stephen Sidney, MD, MPH^d and Heather J. Fullerton, MD, MAS^a,c

^a Departments of Neurology
^b Epidemiology
^c Pediatrics, University of California, San Francisco, California
^d Division of Research, Kaiser Permanente Medical Care Program, Oakland, California

OBJECTIVES. Predictors for perinatal arterial ischemic stroke include both maternal and intrapartum factors, but predictors of perinatal hemorrhagic stroke have not been studied. We sought to determine both the prevalence and predictors of perinatal hemorrhagic stroke within a large, multiethnic population.

PATIENTS AND METHODS. We performed a case-control study nested within the cohort of all infants born from 1993 to 2003 in the Northern California Kaiser Permanente Medical Care Program, a health maintenance organization providing care for >3 million members. Cases of symptomatic perinatal hemorrhagic stroke and perinatal arterial ischemic stroke in neonates (28 weeks' gestational age through 28 days of life) were identified through electronic searches of diagnosis and radiology databases and confirmed by medical chart review. Three controls per case were randomly selected and matched on birth year and facility. This analysis included cases of perinatal hemorrhagic stroke (intracerebral hemorrhage or subarachnoid hemorrhage, excluding pure intraventricular hemorrhage) and all controls. Predictors of perinatal hemorrhagic stroke were assessed by using logistic regression, adjusting for the matching criteria.

RESULTS. Among 323 532 live births, we identified 20 cases of perinatal hemorrhagic stroke (19 intracerebral hemorrhage and 1 subarachnoid hemorrhage), which yielded a population prevalence for perinatal hemorrhagic stroke of 6.2 in 100 000 live births. Cases presented with encephalopathy (100%) and seizures (65%). Perinatal hemorrhagic stroke was typically unifocal (74%) and unilateral (83%). Etiologies included thrombocytopenia (n = 4) and cavernous malformation (n = 1); 15 (75%) were idiopathic. Univariate predictors of perinatal hemorrhagic stroke included male gender, fetal distress, emergent cesarean delivery, prematurity, and postmaturity but not birth weight. When entered into a multivariate model, fetal distress and postmaturity continued to be independent predictors.

CONCLUSIONS. Fetal distress is an independent predictor of perinatal hemorrhagic stroke, perhaps suggesting a prenatal event. Postmaturity also predicts perinatal hemorrhagic stroke, an association not explained by large birth weight in our study.

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Key Words: cerebral hemorrhage • neonatal

Abbreviations: PHS—perinatal hemorrhagic stroke • PAS—perinatal arterial ischemic stroke • KPMCP—Kaiser Permanente Medical Care Program • ICH—intracerebral hemorrhage • SAH—subarachnoid hemorrhage • IVH—intraventricular hemorrhage • CI—confidence interval • OR—odds ratio

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Accepted Jun 27, 2008.

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