Elsevier

The Journal of Pediatrics

Volume 172, May 2016, Pages 156-161.e3
The Journal of Pediatrics

Original Article
Multimodal Outcome at 7 Years of Age after Neonatal Arterial Ischemic Stroke

https://doi.org/10.1016/j.jpeds.2016.01.069Get rights and content

Objectives

To evaluate the epileptic, academic, and developmental status at age 7 years in a large population of term-born children who sustained neonatal arterial ischemic stroke (NAIS), and to assess the co-occurrence of these outcomes.

Study design

A cohort study including 100 term newborns with NAIS was designed. Two infants died during the neonatal period, 13 families were lost to follow-up, and 5 families declined to participate in this evaluation. Thus, 80 families completed the 7-year clinical assessment. Epileptic status, schooling, motor abilities, global intellectual functioning, spoken language, and parental opinions were recorded. Principal component analysis was applied.

Results

Rates of impaired language, cerebral palsy, low academic skills, active epilepsy, and global intellectual deficiency were 49%, 32%, 28%, 11%, and 8%, respectively. All were highly correlated. Eventually, 59% of children were affected by at least 1 of the aforementioned conditions. In 30% of cases, the viewpoints of health practitioners and parents did not match.

Conclusion

The prevalence of severe disabilities at 7 years after NAIS is low, but most children exhibit some impairment in developmental profile.

Trial registration

ClinicalTrials.gov (NCT02511249), Programme Hospitalier de Recherche Clinique Régional (0308052), Programme Hospitalier de Recherche Clinique Interrégional (1008026), and EudraCT (2010-A00329-30).

Section snippets

Methods

The objective of the AVCnn study was to better delineate the risk factors, clinical and imaging presentation, mechanisms, and outcomes of NAIS, while avoiding the confounders described above. The study was conducted in accordance with international ethical standards and the Declaration of Helsinki. The current evaluation at age 7 years was approved by the Regional Ethics Committee in May 2010. Informed consent was obtained from each participant. The reporting of results follows the general

Results

Of the 100 patients (Figure 1; available at www.jpeds.com), 2 died in the neonatal period, and 13 families were lost to follow-up. Of the 85 families contacted for the 7-year assessment, 5 declined to participate and 73 accepted. Seven other families refused to participate in the encounter but agreed to complete part of the evaluation by phone. In these families, data on epilepsy, schooling, and parental opinions were recorded.

Data were available for 80 families (82% of the survivors). The

Discussion

In this cohort of term newborns with NAIS, most children exhibited some sequelae 7 years later; however, severe disability, such as drug-resistant epilepsy, moderate/severe CP (GMFCS ≥III or BFMF ≥3), or global intellectual deficiency, is the exception: 6%, 3%, and 8%, respectively, with a major co-occurrence. In other words–and to answer to a common question of parents–all were able to walk independently and to talk. These results are in line with previously reported data, but our study has

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    Funded by Ministère de la santé et des solidarités (0308052 and 1008026), Centre hospitalier universitaire de Saint-Étienne (085), Fondation motrice, Fondation Garches, Association des paralysés de France, and Fondation de France. The authors declare no conflicts of interest.

    List of additional AVCnn Study Group members is available in the Appendix (available at www.jpeds.com).

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