深圳市新生儿脑卒中多中心现况调查

A multicenter study of neonatal stroke in Shenzhen, China

摘要:

目的 总结深圳市新生儿脑卒中发病率、临床特征及预后等情况，提高脑卒中新生儿的早期诊治能力。方法 由深圳市儿童医院牵头，收集2020年1月—2022年12月深圳新生儿数据协作网组织21家单位收治的新生儿脑卒中36例，分析深圳市新生儿脑卒中发病率、临床特征、治疗、预后等情况。结果 深圳市21家医院2020、2021、2022年新生儿脑卒中的发病率分别为1/15 137、1/6 060、1/7 704。缺血性脑卒中占75%（27/36），男性患儿占64%（23/36）。86%（31/36）的患儿在生后3 d内起病，53%（19/36）以惊厥起病。颅脑影像学结果显示，22例（61%）大脑左侧发生梗死，13例（36%）基底节梗死；12例完成磁共振血管成像检查，9例（75%）累及大脑中动脉。29例患儿完成脑电图检查，21例（72%）出现尖波，10例（34%）出现电发作。不同医院对症支持治疗不同。12例（33%）完善新生儿行为神经测定评分，平均得分（32±4）分。共随访27例患儿12月龄左右的预后情况，44%（12/27）的患儿预后良好。结论 新生儿脑卒中主要为缺血性脑卒中，多以惊厥为首发症状，多累及大脑中动脉，脑电图多出现尖波，神经发育评分较低，以对症支持治疗为主，部分患儿预后不良。

Abstract:

Objective To investigate the incidence rate, clinical characteristics, and prognosis of neonatal stroke in Shenzhen, China.Methods Led by Shenzhen Children's Hospital, the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022. The incidence, clinical characteristics, treatment, and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137, 1/6 060, and 1/7 704, respectively. Ischemic stroke accounted for 75% (27/36); boys accounted for 64% (23/36). Among the 36 neonates, 31 (86%) had disease onset within 3 days after birth, and 19 (53%) had convulsion as the initial presentation. Cerebral MRI showed that 22 neonates (61%) had left cerebral infarction and 13 (36%) had basal ganglia infarction. Magnetic resonance angiography was performed for 12 neonates, among whom 9 (75%) had involvement of the middle cerebral artery. Electroencephalography was performed for 29 neonates, with sharp waves in 21 neonates (72%) and seizures in 10 neonates (34%). Symptomatic/supportive treatment varied across different hospitals. Neonatal Behavioral Neurological Assessment was performed for 12 neonates (33%, 12/36), with a mean score of (32±4) points. The prognosis of 27 neonates was followed up to around 12 months of age, with 44% (12/27) of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke, often with convulsions as the initial presentation, involvement of the middle cerebral artery, sharp waves on electroencephalography, and a relatively low neurodevelopment score. Symptomatic/supportive treatment is the main treatment method, and some neonates tend to have a poor prognosis.