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

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.