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OBJECTIVE. Few data exist regarding rates and predictors of recurrence after childhood arterial ischemic stroke. We sought to establish such rates within a large, multiethnic population and determine whether clinical vascular imaging predicts recurrence. PATIENTS AND METHODS. In a population-based cohort study, we collected data on all documented cases of arterial ischemic stroke among 2.3 million children ( RESULTS. Among 181 incident childhood stroke cases (84 perinatal; 97 later childhood), there were 16 recurrent strokes (1 after a perinatal stroke) at a median of 2.7 months. The 5-year cumulative recurrence rates were 1.2% after perinatal stroke and 19% after later childhood stroke. Of the 97 children with later childhood strokes, 52 received cerebrovascular imaging, predominantly magnetic resonance angiography (n = 36) and conventional angiography (n = 26). Although there were no recurrences among children with normal vascular imaging, children with a vascular abnormality had a 5-year cumulative recurrence rate of 66%. CONCLUSIONS. Strokes recur in one fifth of cases of later childhood arterial ischemic stroke but are rare after perinatal stroke. Among the later childhood cases, cerebrovascular imaging identifies those at highest risk for recurrence., DESPITE INCREASING RECOGNITION of arterial ischemic stroke (AIS) as an important cause of childhood disability, few data exist regarding rates and predictors of recurrent childhood stroke. (1,2) Although children with [...]

Objective. Birth asphyxia is recognized as an important cause of neonatal morbidity and mortality. Whether advances in perinatal care have altered the incidence of birth asphyxia is unknown. We determined the incidence of birth asphyxia diagnoses made over a 10-year period in California. Methods. In a population-based retrospective cohort study of 5 364 663 live births, we determined the incidence and case fatality of birth asphyxia between 1991 and 2000. Using a statewide administrative hospital discharge database, we identified all newborn admissions that generated a diagnosis of birth asphyxia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 768.5, 768.6, or 768.9) or a diagnosis that overlaps with birth asphyxia, such as congenital encephalopathy or fetal distress. We determined incidence and in-hospital case fatality rates adjusted for birth weight and demographic characteristics and stratified by associated perinatal complications. Results. The 24 330 newborns who received a diagnosis of birth asphyxia yielded a population incidence of 4.5 per 1000 live births. Black ethnicity (relative risk [RR]: 1.3; 95% confidence interval [CI]: 1.2-1.3), male gender (RR: 1.2; 95% CI: 1.1-1.2), and low socioeconomic status (RR: 1.2; 95% CI: 1.1-1.2) all were associated with increased risk. The diagnosis of birth asphyxia decreased by 91% from 14.8 to 1.3 per 1000 live births during the study years. This decrease could not be explained by an increased diagnosis of overlapping conditions. Overall case fatality was 4%, and the majority of deaths in infants >2000 g occurred in the presence of congenital anomalies, cord abnormalities, or maternal hemorrhage. In newborns Conclusion. The diagnosis of birth asphyxia has decreased dramatically in recent years. The factors that are responsible for this decline are unclear and deserve additional investigation. Pediatrics 2004;114:1584-1590; asphyxia, epidemiology, neonatal. ABBREVIATIONS. OSHPD, Office of Statewide Health Planning and Development; ICD-9-CM, Classificalion of Diseases, Ninth Revision, Clinical Modification; SES, socioeconomic status; LBW, low birth weight; VLBW, very low birth weight; IUGR, intrauterine growth restriction; RR, reiative risk; CI, confidence interval., The clinical diagnosis of birth asphyxia, along with the closely related conditions of hypoxicischemic encephalopathy and newborn encephalopathy, is recognized as an important cause of morbidity and mortality in newborn [...]