Lee et al identified risk factors for perinatal arterial stroke (PAS) in the newborn infant. PAS may be associated with hemiplegic cerebral palsy. The authors are from University of California San Francisco and Kaiser Permanente.


Population prevalence of PAS: 20 per 100,000 live births


Presentation of PAS:

(1) neonatal seizures

(2) demonstration of intraventricular hemorrhage or white matter abnormalities on head CT

(3) pathologic handedness (hand preference before 12 months of age) after 2 months of age

(4) other


Risk factors associated with PAS (Table 3, page 727):

(1) infertility (maternal or paternal infertility apparently not distinguished, but with use of ovarian stimulation a risk factor)

(2) pre-eclampsia or pregnancy-induced hypertension

(3) primiparity

(4) chorioamnionitis

(5) prolonged rupture of the membranes (which is a risk factor for chorioamnionitis)

(6) oligohydramnios

(7) prolonged second stage of labor (> 2 hours, which correlates with primiparity)

(8) decreased fetal movements

(9) fetal heart rate abnormalities


total number of risk factors =

= SUM(number of risk factors present)



• minimum number of risk factors: 0

• maximum number of risk factors: 9

• The presence of 3 or more risk factors was associated with a prevalence of PAS at about 1 in 200 births.


Risk factors that were independent on multivariate analysis (page 727):

(1) history of infertility (especially with use of ovarian stimulation drugs)

(2) pre-eclampsia

(3) chorioamnionitis

(4) prolonged rupture of the membranes

(5) prolonged second stage of labor



• Many of the risk factors are fairly common, while the occurrence of PAS is relatively low. The predictive value of the risk factors for a particular infant is low.


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