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May 15, 2026

Neonatal stroke active surveillance BPSU study in the UK and the Republic of Ireland with a meta-analysis of national surveillance studies

Key Points

The aim is to assess the incidence, presentation, management, and short-term outcomes of neonatal stroke in the UK and Ireland.
Active surveillance study through the British Paediatric Surveillance Unit.
Data collection from clinicians via questionnaires and neuroimages from March 2022 to April 2023.
Meta-analysis included over 3 million infants to compare findings.
68 neonatal stroke cases were reported, with an incidence of 9.0 per 100,000 live births (95% CI 6.9 to 11.6).
Three-quarters of cases were arterial ischaemic, primarily presenting with seizures at 2–3 days of age.
82% of infants were discharged home at a median of 12 days with various follow-up interventions.

Abstract

Objective Assess the incidence, presentation, management and short-term outcomes of neonatal stroke in the UK and Ireland (ROI). Design Active surveillance (British Paediatric Surveillance Unit) study and meta-analysis of national surveillance studies. Setting UK and ROI. Patients Neonatal stroke presenting <90 days old in term and preterm infants between March 2022 and April 2023. Interventions Reporting clinicians completed questionnaires and uploaded de-identified neuroimages via a purpose-built data platform. Results 68 neonatal stroke cases were reported in the UK and ROI. UK incidence was 9.0 per 100 000 live births (95% CI 6.9 to 11.6). Three-quarters were arterial ischaemic and unilateral. Arterial ischaemic and cerebral venous sinus thrombosis (CVST) strokes commonly presented with seizures at 2–3 days of age, while haemorrhagic stroke commonly presented with encephalopathy in the first ten days of age. Neonatal stroke was associated with fetal distress in utero. 61% of infants had an umbilical pH <7.25 and 28% required significant resuscitation at birth, respectively. A meta-analysis of 3 607 864 infants found our reported incidence and associated conditions were similar to surveillance studies in Germany and Australia. Guidelines were available in a quarter of reporting hospitals. 87% of infants with arterial ischaemic and CVST stroke received antiseizure medications. 82% of infants were discharged home at 12 days old (median) with antiseizure medications (42%) alongside paediatric/neonatal (91%), physiotherapy (77%) and paediatric neurology (63%) follow-up. Conclusions Neonatal stroke is rare, with distinct subtypes associated with different presentations, timings and management strategies, highlighting the need to better understand this condition.

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