Cerebral infarction in the term newborn: Clinical presentation and long-term outcome

Objective: We evaluated the long-term neurodevelopmental outcome of cranial computed tomography (CT)-documented cerebral infarction in term neonates t o ascertain factors that would help to predict the risk of subsequent neuro developmental sequelae in early childhood. Study design: From 1983 to 1997, all surviving neonates from two level III neonatal intensive care units were prospectively identified and subsequentl y assessed in childhood. Clinical presentation was characterized by retrosp ective chart review and blinded re-reading of computed tomography (CT) scan s. Perinatal events were compared with neurodevelopmental outcome. Results: Forty-six children were followed up for a mean of 42.1 months (ran ge, 18-164 months). Neurodevelopmental outcome was normal in 15 and abnorma l in 31. A single disability was present in 8, and multiple disabilities we re present in 23. Cerebral palsy was present in 22 and cognitive impairment in 19. Abnormal findings on neurologic examination at discharge and seizur es in the neonatal period were associated with the presence of one or more childhood disabilities. The site or laterality of the vascular distribution of the lesion on neonatal CT did not correlate with long-term outcome. Conclusion: After cerebral infarction in the neonatal period, one third of term infants have normal long-term development. Neonatal seizure history an d the findings on neurologic examination at discharge help in counseling pa rents about the possible long-term outcome of neonatal stroke.