Neonatal Stroke Active Surveillance Study in the United Kingdom and Ireland with meta-analysis of surveillance studies

Background Neonatal stroke is a rare but devastating condition. This study explored the incidence, clinical presentation, management and short-term outcomes of neonatal stroke across five countries in the United Kingdom (UK) and Republic of Ireland (ROI) in the post-COVID-19 era. Methods This active surveillance study identified neonatal stroke cases presenting before 90 days of life between March 2022-April 2023 in the UK and ROI using the monthly British Paediatric Surveillance Unit (BPSU) reporting system. Reporting clinicians completed questionnaires and uploaded de-identified neuroimages via a purpose-built data platform. A meta-analysis of neonatal stroke active surveillance studies was performed. Results 68 neonatal stroke cases were reported. UK incidence of neonatal stroke was 9.0 per 100,000 live births (95% CI 6.9-11.6). Three-quarters of the cases were arterial ischaemic and unilateral. Arterial ischaemic and cerebral venous sinus thrombosis (CVST) strokes commonly presented with seizures at two-three days of age, while haemorrhagic stroke commonly presented with encephalopathy in the first ten days of age. Neonatal stroke cases were associated with fetal distress in utero. 61% and 28% of infants had an umbilical cord pH <7.25 and required significant resuscitation at birth, respectively. A meta-analysis of 3,607,864 infants found the incidence and associated conditions were similar to pre-COVID-19 surveillance studies in Germany and Australia. Neonatal stroke guidelines were available in a quarter of the reporting hospitals. 87% of infants with arterial ischaemic and CVST stroke received antiseizure medications. 82% of infants were discharged home at a median of 12 days old with antiseizure medications (42%) alongside paediatric/neonatal (91%), physiotherapy (77%) and paediatric neurology (63%) follow-up. Conclusions Neonatal stroke is a rare disease with distinct subtypes associated with different clinical presentations, timings and management strategies, highlighting the need to better understand this condition. The incidence pre- and post-COVID-19 appeared similar. Funding 2019 BPSU Sir Peter Tizard Award