BPSU study - Neonatal stroke presenting/diagnosed in the first 90 days of life

Surveillance of neonatal stroke is to commence in April 2022. The study is led by Tizard bursary winner Dr T’ng Kwok and will provide a current description of neonatal stroke including the associated factors, management and outcomes. By exploring how babies with neonatal stroke present and are cared for, future studies looking at prevention and new treatment options can be better designed.

Lead investigator

Dr T’ng Chang Kwok

Division of Child Health, Obstetrics and Gynaecology
The University of Nottingham
Derby Road
Nottingham NG7 2UH
Email:Tng.kwok@nottingham.ac.uk

Profressor Don Sharkey

Division of Child Health, Obstetrics and Gynaecology
The University of Nottingham
Derby Road
Nottingham NG7 2UH
Email:Don.Sharkey@nottingham.ac.uk

About the study

Overview

Neonatal stroke is a devastating condition that causes brain injury in babies and often leads to lifelong impairment. Neonatal stroke occurs when the blood supply to the brain is disrupted in babies. Children with this condition may have problems walking, moving their arms or expressing themselves. Some may develop fits throughout childhood. 

Presently, we have insufficient information about the number of babies with neonatal stroke. Most clinicians will see only a few cases in their career. Therefore, we know little about which babies are most at risk and what problems they will likely face. There is also no agreed guidance on how we should investigate and treat babies with stroke. This is unlike stroke in older children and adults where much more is known. 

The study aims to answer these questions and raise awareness of neonatal stroke amongst clinicians, as it is often under-reported. Clinicians will notify the research team, through the British Paediatric Surveillance Unit, if they care for a baby with neonatal stroke in the first 3 months of life.

Notifying clinicians will be directed to the online questionnaires via the dedicated BPSU online platform. This study will provide a current description of neonatal stroke including the associated factors, management and outcomes. This will inform clinicians and policy developers of the burden of neonatal stroke to better allocate resources. By exploring how babies with neonatal stroke present and are cared for, future studies looking at prevention and new treatment options can be better designed. Ultimately, this study could prevent neonatal stroke and improve care for these babies through specialist support and treatment. 

You can download the protocol card, including references, below. All reporting clinicians will be part of the UK and Ireland Neonatal Stroke Study team with contributions acknowledged in all publications arising from the study.

Case definition

Neonatal stroke, of either arterial ischaemic, venous thrombosis or haemorrhagic in origin, suspected in any child from birth till 90 days of age, of any gestation. They must have:

  1. Any neurological symptoms (including seizure, neurological deficit, lethargy, abnormal tone, poor feeding) 

AND either

    2a. Neuroimaging (such as MRI or CT) showing disruption or evidence of disruption of cerebral blood flow

    2b. Neuropathologic studies showing disruption or evidence of disruption of cerebral blood flow

Please exclude cases of germinal matrix haemorrhage/intraventricular haemorrhage or periventricular leukomalacia in preterm infants (defined as below 37 weeks of gestational age) or hypoxic ischaemic encephalopathy.

Duration

March 2022 – March 2023 (13 months surveillance) with questionnaire open till April 2023 for cases seen in March 2023. Follow up until March 2025

Funding

This study has secured funding from the 2019 Sir Peter Tizard bursary.

Approval

This study has been approved by HSC-PBPP, HRA and HCRW Approval (REC reference: 1/EM/0110; IRAS project ID: 291069) and has been granted Section 251 HRA-CAG permission (CAG Reference: 21/CAG/0061).

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