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.

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.

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.

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 Competing Interest Statement The authors have declared no competing interest. Clinical Protocols https://www-degruyterbrill-com.nottingham.idm.oclc.org/document/doi/10.1515/med-2022-0554/html Funding Statement The study is funded by the 2019 Sir Peter Tizard award to TCK from the BPSU. No competing interests were disclosed. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study received ethics approval from the UK Health Research Authority Research Ethics Committee (Reference 21/EM/0110) on advice from the Confidentiality Advisory Group (England and Wales) (Reference 21/CAG/0061); the Public Benefit and Privacy Panel (Scotland) (Reference 2122-0006 Kwok); and the chair of the Privacy Advisory Committee (Northern Ireland). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Social media handles, @UoNMedicine @NUHNeonatal @theBPSU @tngchang @tngchang.bsky.social @donsharkey.bsky.social Data Availability Access to the de-identified data could be requested from the corresponding author after relevant regulatory approvals. The full study protocol, including the study questionnaires, could be found online. https://www-degruyterbrill-com.nottingham.idm.oclc.org/document/doi/10.1515/med-2022-0554/html