Risk Factors for Perinatal Arterial Ischemic Stroke: A Machine Learning Approach.

Journal: Neurology
Published Date: May 15, 2024

Abstract

BACKGROUND AND OBJECTIVES: Perinatal arterial ischemic stroke (PAIS) is a focal vascular brain injury presumed to occur between the fetal period and the first 28 days of life. It is the leading cause of hemiparetic cerebral palsy. Multiple maternal, intrapartum, delivery, and fetal factors have been associated with PAIS, but studies are limited by modest sample sizes and complex interactions between factors. Machine learning approaches use large and complex data sets to enable unbiased identification of clinical predictors but have not yet been applied to PAIS. We combined large PAIS data sets and used machine learning methods to identify clinical PAIS factors and compare this data-driven approach with previously described literature-driven clinical prediction models.

Authors

  • Ratika Srivastava
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Lauran Cole
    Department of Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
  • Kimberly Amador
    Department of Radiology, University of Calgary, Calgary, AB, Canada.
  • Nils Daniel Forkert
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Mary Dunbar
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Michael I Shevell
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Maryam Oskoui
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Anna P Basu
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Michael J Rivkin
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Eilon Shany
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Linda S de Vries
  • Deborah Dewey
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Nicole Letourneau
    From the Division of Pediatric Neurology (R.S., L.C.), Department of Pediatrics, University of Alberta; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (K.A.); Department of Clinical Neurosciences (N.D.F.); Department of Pediatrics and Clinical Neurosciences (M.D.), University of Calgary, Alberta; Departments of Pediatrics and Neurology/Neurosurgery (M.I.S., M.O.), McGill University, Montreal, Quebec, Canada; Newcastle upon Tyne Hospitals (A.P.B.), NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Neurology (M.J.R.), Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neonatology (E.S.), Soroka University Medical Center and Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology (L.S.V.), University Medical Center Utrecht, The Netherlands; Departments of Pediatrics and Community Health Sciences (D.D.), Owerko Centre at the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine; Faculty of Nursing and Cumming School of Medicine (N.L.), Departments of Pediatrics, Psychiatry and Community Health Sciences; Alberta Children's Hospital Research Institute and Department of Clinical Neurosciences (P.M.); Departments of Clinical Neurosciences (M.D.H.), Community Health Sciences, Medicine and Radiology, Hotchkiss Brain Institute and Department of Pediatrics (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Pauline Mouches
    Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
  • Michael D Hill
    Calgary Stroke Program, Departments of Clinical Neurosciences, Radiology, Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
  • Adam Kirton
    University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada Hotchkiss Brain Institute, Calgary, Albreta, Canada adam.kirton@albertahealthservices.ca.

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