Neuroimaging and Neurological Outcomes in Perinatal Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis

Lisa Pabst*, Catherine R. Hoyt, Ryan J. Felling, Alyssa E. Smith, Karen Harpster, Andrea C. Pardo, Jeffrey A. Bridge, Bin Jiang, Alison Gehred, Warren Lo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Prediction of outcomes in perinatal arterial ischemic stroke (PAIS) is challenging. We performed a systematic review and meta-analysis to determine whether infarct characteristics can predict outcomes in PAIS. Methods: A systematic search was conducted using five databases in January 2023. Studies were included if the sample included children with neonatal or presumed PAIS; if infarct size, location, or laterality was indicated; and if at least one motor, cognitive, or language outcome was reported. The level of evidence and risk of bias were evaluated using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analyses were conducted comparing infarct size or location with neurological outcomes when at least three studies could be analyzed. Results: Eighteen full-text articles were included in a systematic review with nine included in meta-analysis. Meta-analyses revealed that small strokes were associated with a lower risk of cerebral palsy/hemiplegia compared with large strokes (risk ratio [RR] = 0.263, P = 0.001) and a lower risk of epilepsy (RR = 0.182, P < 0.001). Middle cerebral artery (MCA) infarcts were not associated with a significantly different risk of cerebral palsy/hemiplegia compared with non-MCA strokes (RR = 1.220, P = 0.337). Bilateral infarcts were associated with a 48% risk of cerebral palsy/hemiplegia, a 26% risk of epilepsy, and a 58% risk of cognitive impairment. Conclusions: Larger stroke size was associated with worse outcomes across multiple domains. Widely heterogeneous reporting of infarct characteristics and outcomes limits the comparison of studies and the analysis of outcomes. More consistent reporting of infarct characteristics and outcomes will be important to advance research in this field.

Original languageEnglish (US)
Pages (from-to)19-28
Number of pages10
JournalPediatric neurology
Volume157
DOIs
StatePublished - Aug 2024

Funding

Dr. Lo receives research grant support from the NINDS and NICHD. Dr. Bridge receives research grant support from the National Institute of Mental Health, the Centers for Disease Control and Prevention, and the Patient-Centered Outcomes Research Institute; he is also a member of the Scientific Advisory Board of Clarigent Health. The other authors declare no conflicts of interest. Funding: None.

Keywords

  • Arterial ischemic stroke
  • Cerebral palsy
  • Epilepsy
  • Perinatal stroke

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

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