TY - JOUR
T1 - Early predictors of neurodevelopment after perinatal arterial ischemic stroke
T2 - a systematic review and meta-analysis
AU - Baak, Lisanne M
AU - van der Aa, Niek E
AU - Verhagen, Annemijn A E
AU - Dudink, Jeroen
AU - Groenendaal, Floris
AU - Nijboer, Cora H A
AU - Benders, Manon J N L
AU - Wagenaar, Nienke
N1 - Funding Information:
We performed this systematic review according to PRISMA guidelines (Supplementary Tables and ). The review was registered and the protocol published in Prospero (#CRD42020220508). We searched studies that included at least five infants to assess the long-term prognostic value of diagnostic procedures and early (neuro)developmental assessments performed in neonates with PAIS within four months of age. This work was supported by the European Society for Pediatric Research (ESPR). The funder had no role in the study design, data collection and analysis, preparation of the manuscript or decision to publish.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
PY - 2023/7
Y1 - 2023/7
N2 - Background and aims: Perinatal arterial ischemic stroke (PAIS) often has lifelong neurodevelopmental consequences. We aimed to review early predictors (<4 months of age) of long-term outcome. Methods: We carried out a systematic literature search (PubMed and Embase), and included articles describing term-born infants with PAIS that underwent a diagnostic procedure within four months of age, and had any reported outcome parameter ≥12 months of age. Two independent reviewers included studies and performed risk of bias analysis. Results: We included 41 articles reporting on 1395 infants, whereof 1255 (90%) infants underwent follow-up at a median of 4 years. A meta-analysis was performed for the development of cerebral palsy (n = 23 studies); the best predictor was the qualitative or quantitative assessment of the corticospinal tracts on MRI, followed by standardized motor assessments. For long-term cognitive functioning, bedside techniques including (a)EEG and NIRS might be valuable. Injury to the optic radiation on DTI correctly predicted visual field defects. No predictors could be identified for behavior, language, and post-neonatal epilepsy. Conclusion: Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS. Future research should be focused on improving outcome prediction for non-motor outcomes. Impact: We present a systematic review of early predictors for various long-term outcome categories after perinatal arterial ischemic stroke (PAIS), including a meta-analysis for the outcome unilateral spastic cerebral palsy.Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS, while bedside techniques such as (a)EEG and NIRS might improve cognitive outcome prediction.Future research should be focused on improving outcome prediction for non-motor outcomes.
AB - Background and aims: Perinatal arterial ischemic stroke (PAIS) often has lifelong neurodevelopmental consequences. We aimed to review early predictors (<4 months of age) of long-term outcome. Methods: We carried out a systematic literature search (PubMed and Embase), and included articles describing term-born infants with PAIS that underwent a diagnostic procedure within four months of age, and had any reported outcome parameter ≥12 months of age. Two independent reviewers included studies and performed risk of bias analysis. Results: We included 41 articles reporting on 1395 infants, whereof 1255 (90%) infants underwent follow-up at a median of 4 years. A meta-analysis was performed for the development of cerebral palsy (n = 23 studies); the best predictor was the qualitative or quantitative assessment of the corticospinal tracts on MRI, followed by standardized motor assessments. For long-term cognitive functioning, bedside techniques including (a)EEG and NIRS might be valuable. Injury to the optic radiation on DTI correctly predicted visual field defects. No predictors could be identified for behavior, language, and post-neonatal epilepsy. Conclusion: Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS. Future research should be focused on improving outcome prediction for non-motor outcomes. Impact: We present a systematic review of early predictors for various long-term outcome categories after perinatal arterial ischemic stroke (PAIS), including a meta-analysis for the outcome unilateral spastic cerebral palsy.Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS, while bedside techniques such as (a)EEG and NIRS might improve cognitive outcome prediction.Future research should be focused on improving outcome prediction for non-motor outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85144957547&partnerID=8YFLogxK
U2 - 10.1038/s41390-022-02433-w
DO - 10.1038/s41390-022-02433-w
M3 - Review article
C2 - 36575364
SN - 0031-3998
VL - 94
SP - 20
EP - 33
JO - Pediatric Research
JF - Pediatric Research
IS - 1
ER -