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Independent Walking After Neonatal Arterial Ischemic Stroke and Sinovenous Thrombosis

Department of Neurology Division of Pediatric Neurology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, mgolomb{at}iupui.edu.

Gabrielle A. deVeber, MD

Division of Neurology, The Hospital for Sick Children

Daune L. MacGregor, MD

Division of Neurology, The Hospital for Sick Children

Trish Domi, MA

Division of Neurology, The Hospital for Sick Children

Hilary Whyte, MD

Division of Neonatology, The Hospital for Sick Children

Derek Stephens, PhD

Population Health Sciences, The Hospital for Sick Children

Paul T. Dick, MSc

Pediatric Outcomes Research Team and Division of Pediatric Medicine The Hospital for Sick Children, Toronto, ON

Few studies have examined walking after neonatal arterial ischemic stroke and sinovenous thrombosis. We looked at the development of walking in a retrospective and consecutive cohort study of 88 term and near-term neonates. We used Kaplan-Meier survival curves and Cox proportional hazards models to assess (1) sex, (2) stroke type (arterial ischemic stroke or sinovenous thrombosis), (3) number of cerebral hemispheres with infarction, and (4) presence of neonatal comorbidity as predictors of the probability over time of starting to walk independently. These variables were assessed as predictors of parent-reported gait normality using the chi-square test on 2 x 2 contingency tables. Seventy-five of 83 survivors (90.4%, 95% confidence interval = 81.9—95.7) walked with a median time of first steps at 13 months of age (95% confidence interval = 12—14). Only bilateral strokes were associated with a lower probability over time of initiating independent walking (hazard ratio = 0.41, P = .04). Parents reported normal gait for 58 of 75 walkers (77.3%, 95% confidence interval = 67.8—86.8). No variables predicted parent-reported gait normality. Our findings suggest that most survivors of neonatal arterial ischemic stroke and sinovenous thrombosis walk with a gait that appears normal to parents, but bilateral infarctions decrease the probability over time of starting to walk independently. (J Child Neurol 2003;18:530—536).

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