(214) Risk Factors for Ischemic Stroke in Neonates With Congenital Heart Disease

Introduction: Embolic stroke is uncommon in the pediatric population but carries the potential for significant long-term disability. Despite representing < 1% of children, patients with congenital heart defects (CHDs) represent about 20% of pediatric strokes. Given this knowledge, we investigated possible risk factors and comorbidities associated with the development of stroke in patients with CHD requiring neonatal surgical repair.

Methods: We evaluated all children younger than 6 months of age admitted to our tertiary pediatric cardiac intensive care unit between 01/01/2016 and 12/31/2022. We compared patient factors between patients with ischemic stroke and those without stroke using standard statistical analysis.

Results: Four hundred three neonates were identified. Forty episodes of acute embolic stroke occurred in 36 infants (8.9%). Four patients had 2 strokes and there was 1 hemorrhagic conversion. Twenty-seven events (26 patients) occurred following procedures with 4 post-catheterization, 7 post-cardiac surgery, and 7 in patients who had undergone both. Nine events occurred following non-cardiac surgery such as gastrostomy-tube placement. Seventeen episodes were associated with seizure, 6 with changes in neurological examinations, 5 were related to vital signs changes. Compared to children without stroke, a higher proportion of children with stroke had single ventricle physiology (67% vs. 16%, P< 0.001), cyanotic congenital cardiac lesions (89% vs. 49%, P< 0.001) and left ventricular outflow tract obstruction (47% vs. 27%, P=0.018). Compared with infants without embolic stroke, infants with embolic stroke had a higher percentage of STAT 4 and 5 surgeries (67% vs. 29%, P< 0.001), had a cardiac procedure at a younger age (15 vs. 58 days, P< 0.001), and had a higher incidence of cardiac arrest (22% vs. 4%, P< 0.001) and need for ECMO support (56% vs. 10%, p< 0.001) with higher mortality (33.3% vs. 6.5%, P< 0.001). There were 12 deaths in infants with embolic strokes with 3 related to acute cerebral ischemic events.

Conclusions: Infants with acute cerebral ischemic events were more frequently affected by single ventricle or cyanotic cardiac lesions. Strokes commonly occurred in the periprocedural period with an association with cardiac arrest, mechanical circulatory support, and increased mortality.