Abstract WP175: A National, Population Based Study Of Neonatal Hemorrhagic And Ischemic Stroke

Background: Neonatal stroke occurs in an estimated 1 in 3000 live births and is the most common cause of hemiplegic cerebral palsy in term infants. Most population based studies on neonatal stroke in the past have been single center or regional, focused only on ischemic stroke, and with less than 100 cases. Large administrative datasets can provide information on comorbid perinatal conditions in neonatal stroke. Methods: Data for patients aged 0-28 days with a diagnosis of either ischemic or hemorrhagic stroke (either subarachnoid or intracerebral hemorrhage) were extracted from the Cerner Health Facts EMR database from 2000-2018. Incidence of birth demographics, perinatal complications, anti-epileptic use, and aspirin use was assessed. Odds ratios were calculated against a cohort of neonates without stroke. Results: Among 1,591,104 neonates in the Cerner EMR database, 452 (59%) neonates were identified with ischemic stroke and 311 (41%) with hemorrhagic stroke. The most common comorbidities for ischemic stroke were neonatal sepsis (16%, OR=13.1), head and scalp birth injury (13%, OR=7.1) and hypoxic injury (12%, OR=38.7). The most common comorbidities for hemorrhagic stroke were head and scalp birth injury (30%, OR=19.5), prematurity (26%, OR=4.2) and neonatal sepsis (23%, OR=13.1). Procedure codes for intubation, neonatal resuscitation, and epinephrine use were prominent in both hemorrhagic (15.1%, OR=35) and ischemic stroke (8.9%, OR=19.1). The proportion of hemorrhagic and ischemic stroke patients receiving antiepileptics was 23% and 27%, respectively. The proportion of ischemic stroke patients who received aspirin was 16.4%. Conclusion: This population based study of neonatal stroke, the largest of its kind, demonstrated a wide variety of comorbid conditions with ischemic and hemorrhagic stroke. Antiepileptic use is common in neonatal ischemic stroke, though in our population-based study of both academic and non-academic centers the prevalence is less than prior estimates. Sepsis, head and scalp injuries, prematurity, and hypoxic injury are associated with neonatal hemorrhagic and ischemic stroke, though prevalence varies between types. More study is needed on specific risk factors and pathogenesis in neonatal stroke.