Newborn brain infarction: clinical aspects and magnetic resonance imaging.

OBJECTIVE: We describe the clinical and imaging studies of 11 full-term babies with neonatal stroke. We classify the neonatal non-hemorrhagic strokes as thrombotic, embolic, or global vascular insufficiency and determine if this classification is improved by adding magnetic resonance spectroscopy (MRS) and diffusion-weighted imaging (DWI) to conventional magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). METHODS: Clinically, eight of the 11 babies presented with seizures, one with apnea, and two with lethargy. Conventional MRI and DWI were used to classify each infarct as being either borderzone or vascular distribution. The location of infarction revealed the presumed vascular pathophysiology. RESULTS: Infants were classified as having either embolic (bilateral middle cerebral artery,n=1), global ischemic (bilateral borderzone, n=2), or thrombotic infarction (unilateral middle cerebral artery, n=7; bilateral posterior cerebral arteries, n=1). DWI and MRS detected a small infarct better than conventional MRI in one patient. MRA showed abnormal intracranial arteries in three, all of who were in the thrombotic group. Even though MRS was more sensitive than conventional MRI in detecting ischemia/infarction in one patient, in another there was no detectable lactate in the stroke region found on conventional MRI. Clinical presentation was similar in global ischemia and focal infarctions, but newborn stroke was more likely to present with lateralizing focal motor seizures. Seizures were the most common presenting sign, with a paucity of other focal neurological deficits. CONCLUSION: MRI is the best approach to determine stroke pathophysiology. Brain infarction frequently presents with seizures. We speculate that the location and distribution of infarction might determine stroke timing, pathophysiology and outcome. Ongoing clinical studies will likely clarify this speculation.

Neonatal outcome of infants born at 500 to 800 grams from 1990 through 1998 in a tertiary care center.

OBJECTIVE: To assess if there have been changes in survival, demographic data, obstetric features, neonatal morbidity, and short-term neurologic/radiographic/neurosensory outcome of 500- to 800-g infants born in a tertiary care neonatal center from 1990 through 1998. STUDY DESIGN: Records of all 500- to 800-g infants born at North Shore University Hospital during 1990-1998 were reviewed to determine demographic data, survival by weight and gestational age (GA), obstetric features, neonatal morbidity, and short-term neurologic/radiographic/neurosensory outcome. Newborn infants were grouped into three triennia: 1990-1992, 1993-1995, and 1996-1998 and compared across time. RESULTS: Of the 173 infants admitted to the neonatal intensive care unit, 112 survived. Improved survival was documented: 40% in 1990-1992, 73% in 1993-1995, and 81% in 1996-1998 (p < 0.0001). Improved survival was also noted in each of the three weight cohorts, as well as in infants < or =26 weeks GA. An increased use of antenatal corticosteroids and increased number of deliveries by cesarean section (C/S) were noted across time. The incidence of 0 to 3 Apgar scores at both 1 and 5 minutes decreased across time. Necrotizing enterocolitis in survivors and expected short-term neurologic/radiographic/neurosensory outcome improved between 1990-1992 and 1996-1998, with a trend toward reduced IVH grade III to IV. The incidence of other neonatal morbidities did not change throughout the time period. CONCLUSIONS: The data document that survival rates continued to improve for 500- to 800-g infants throughout the 1990s. This was concurrent with an increase in "low-risk, expected normal" infants, increased number of deliveries by C/S, decreased incidence of low Apgar scores at both 1 and 5 minutes, and an increased use of antenatal corticosteroids.