Published Online
on May 10, 2007

A more recent version of this article appeared on June 1, 2007

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Submitted on December 2, 2006
Revised on January 11, 2007
Accepted on January 12, 2007

Maternal and Infant Characteristics Associated With Perinatal Arterial Stroke in the Preterm Infant

Manon J.N.L. Benders MD, PhD; Floris Groenendaal MD, PhD; Cuno S.P.M. Uiterwaal MD, PhD; Peter G.J. Nikkels MD, PhD; Hein W. Bruinse MD, PhD; Rutger A.J. Nievelstein MD, PhD; and Linda S. de Vries MD, PhD^*

From the Department of Neonatology, Wilhelmina Children’s Hospital (M.J.N.L.B., F.G., L.S.D.V.), the Julius Centre for Health Sciences and Primary Care (C.S.P.M.U.), the Department of Pathology (P.G.J.N.), the Department of Obstetrics, Wilhelmina Children’s Hospital (H.W.B.), and the Department of Radiology (R.A.J.N.), Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, the Netherlands.

^* To whom correspondence should be addressed. E-mail: l.s.devries{at}umcutrecht.nl.

Background and Purpose--Most perinatal arterial stroke (PAS) studies that investigated infant characteristics have excluded preterm infants from the study population. We sought to analyze the imaging findings and antenatal and perinatal risk factors in preterm infants with PAS.

Methods--This was a hospital-based, case-control study of preterm infants. Case infants were confirmed by reviewing brain imaging scans and medical records (n=31). Three controls per case were individually matched with case infants from the study population.

Results--Gestational age ranged between 27 and 36 weeks, and birth weight ranged between 580 and 3180 g. PAS was more common on the left side (61%), and 7% had bilateral PAS. The majority of strokes involved the middle cerebral artery distribution. Involvement of 1 or more lenticulostriate branches was most common among infants with a gestational age of 28 to 32 weeks, but main branch involvement was seen only in those with a gestational age of >32 weeks. Twin-to-twin-transfusion syndrome, fetal heart rate abnormality, and hypoglycemia were identified as independent risk factors for PAS.

Conclusions--Preterm PAS is associated with prenatal, perinatal, and postpartum risk factors. We were unable to identify any maternal risk factors. Involvement of the different branches of the middle cerebral artery changed with an increase in gestational age.

Key words: perinatal arterial stroke • preterm infants • risk factors

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