Antenatal and perinatal factors, early clinical signs, electroencephalograms (EEG), and magnetic resonance imaging (MRI) findings were compared with neurodevelopmental outcome in 24 infants with neonatal cerebral infarction followed at the Dept of Paediatrics, Hammersmith Hospital, London, UK. Infarcts defined by MRI involved a major cerebral vessel in 19 and borderzones in 5. Duration of follow-up ranged from 15 months to 5 years. Of 7 (29%) infants with abnormal neuromotor outcome, 5 were hemiplegic and 2 showed asymmetry of tone or function. None developed seizures. Adverse antenatal factors, present in 11 (46%), perinatal continuous decelerations below 90 with slow recovery in 14, meconium staining in 11, cord blood pH < 7.1 in 2, and Apgar <5/lmin in 5 were not related to outcome. Abnormal signs on neonatal neurologic exam, chiefly hypotonia, were poor prognostic indicators. Both EEG and MRI were predictors of abnormal outcome. Abnormal neonatal EEG background was associated with later hemiplegia whereas epileptic discharges were not predictive. MRI showing involvement of hemispheres, basal ganglia, and internal capsule, but not one or two of these regions, tended to develop hemiplegia or asymmetry of tone. Concomitant thalamic involvement did not increase the risk of poor outcome. [1]

COMMENT. Neonatal EEG and MRI findings may be predictive of later outcome and development of hemiplegia in infants born with cerebral infarcts. Abnormal antenatal and perinatal factors and neonatal hypotonia fail to identify infants with a poor prognosis.