PhD Scientific Days 2022

Budapest, 6-7 July 2022

Clinical Medicine III.

Long-term Neurodevelopmental Outcome of Term Neonates with Perinatal Hemorrhagic Stroke: a Population-based Study

Eszter Vojcek MD1, Rózsa Gráf PhD2, Anna M. László PhD3, Gyula Gyebnar PhD4, Istvan Seri MD, PhD, Professor1,5

1 First Department of Pediatrics, Semmelweis University, Budapest;
2 Department of Rehabilitation, Szent János Hospital and North Buda United Hospitals, Budapest;
3 Department of Applied Statistics, Institute of Mathematics and Basic Sciences, Hungarian University of Agriculture and Life Sciences, Budapest;
4 Department of Neuroradiology, Medical Imaging Center, Semmelweis University, Budapest;
5 Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, United States

Text of the abstract

Introduction: Perinatal hemorrhagic stroke (PHS) carries the risk of significant long-term neurodevelopmental burden on survivors. A better understanding of the relationship between the MRI findings, clinical risk factors and outcome is of major interest to caregivers and families.
Aims: To assess the long-term neurodevelopmental outcome of term neonates diagnosed with PHS and investigate the associations among brain territorial involvement, clinical risk factors and neurodevelopmental outcomes.
Methods: We conducted a population-based study enrolling 55 term neonates with PHS confirmed by MRI born between 2007-2017. Long-term neurodevelopmental outcome was assessed using the Bayley Scales of Infant Development-II, the Brunet-Lézine test and the Binet Intelligence scales-V.
Results: Follow-up was available in 50 (91%) of the infants, at a median age of 60 months [IQR: 35,88]. Forty (40)% of the infants developed according to population norms and developmental disabilities were diagnosed less frequently among neonates with frontal lobe PHS. In a multivariable model, parietal lobe PHS increased the risk for cerebral palsy (OR:6.7 95%CI:1.1-41.4) and cognitive impairment (OR:23.6 95%CI:2.9-194.9), while the involvement of the thalamus and/or basal ganglia was associated with epilepsy (OR:7.0 95%CI:1.3-37.7). Seizures on admission were associated with epilepsy (OR:10.8 95%CI:1.8-64.3). Patients with PHS affecting multiple lobes had poor prognosis.
Conclusion: Parietal lobe hemorrhage, the involvement of the thalamus/basal ganglia, PHS affecting multiple lobes and seizures were independent predictors of chronic neurodevelopmental sequelae, suggesting that the interplay of stroke territorial involvement and clinical risk factors influence the outcome of PHS.
Funding: Financial support for this work was provided by the Semmelweis University grant (EFOP-3.6.3-VEKOP-16-2017-00009) and by the New National Excellence Program of the Ministry for Innovation and Technology from the Source of the National Research, Development and Innovation Fund (ÚNKP-21-3-II-SE-5).