Reevaluating isolated central apnea in early-term and term newborns: A neurological red flag for perinatal stroke

Introduction: Seizures are the most frequent initial symptom of perinatal stroke. Apnea, a less commonly recognized neurological presentation, is a cessation of breathing lasting >15 s or shorter if associated with bradycardia. This study explores a monocentric cohort of newborns with perinatal stroke, emphasizing the role of Isolated Central Apnea (ICA) as a potential early indicator of cerebrovascular insult. Methods: A retrospective review was conducted on newborns (≥36 weeks GA) diagnosed with MRI-confirmed perinatal stroke at our institution between March 2019 and March 2024. Infants with hypoxic-ischemic encephalopathy (HIE), congenital infections, meningoencephalitis, sepsis, or intrauterine stroke were excluded. Clinical data, neuroimaging findings, EEG/aEEG characteristics, and antiepileptic drug (AED) were analyzed. Results: Of 421 newborns who underwent brain MRI, 27 (6 %) were diagnosed with perinatal stroke (16 males; median GA 38.5 weeks; mean BW 3137g). Seizures were the presenting symptom in 18 cases (67 %), while 8 cases (30 %) exhibited ICA as the first sign and an MRI revealing 5 arterial strokes (63 %) and 3 venous strokes (37 %). EEG abnormalities were detected in 7/8 (88 %) cases, while brain ultrasound was abnormal in 5/8 (63 %). AED therapy was required in 7/8 (88 %) patients. Conclusions: ICA is an early sign of neonatal stroke in approximately one-third of cases. These findings underscore the importance of brain MRI in the diagnostic workup of persistent apnea in term and early-term neonates.