[Stroke and Cerebral Sinovenous Thrombosis in the Newborn (S2k-Leitlinie, AWMF-Register-Nr. 024-024, Version 1.0)].

BACKGROUND

Neonatal stroke is a rare but clinically significant neurological disorder associated with substantial morbidity and potentially severe long-term sequelae. Despite advances in diagnostic techniques, uncertainties remain regarding diagnosis, treatment, and follow-up care. The aim of this S2k guideline is to provide evidence- and consensus-based recommendations for the standardized management of neonates with arterial ischemic stroke, hemorrhagic stroke, and cerebral sinovenous thrombosis (CSVT).

METHODS

The guideline was developed through a structured S2k consensus process involving multidisciplinary professional societies and experts. Recommendations were based on a systematic review of the available literature and a formal consensus procedure to establish diagnostic and therapeutic guidance.

RESULTS

The guideline defines neonatal stroke as the acute onset of neurological symptoms within the first 28 days of life associated with a cerebrovascular event confirmed by magnetic resonance imaging (MRI). Given the frequently nonspecific clinical presentation, particularly seizures, apnea, and altered consciousness, prompt diagnostic evaluation is recommended. Initial neuroimaging should consist of transfontanellar cranial ultrasonography including Doppler assessment, followed by MRI with diffusion-weighted imaging and vascular imaging, which represents the diagnostic gold standard. Computed tomography is not recommended because of radiation exposure and limited diagnostic sensitivity. Neonates with suspected stroke or seizures should undergo continuous neurophysiological monitoring using bilateral amplitude-integrated electroencephalography (aEEG). Routine screening for inherited thrombophilia is not recommended in cases of arterial ischemic stroke. Supportive management aimed at maintaining normoxia, normocapnia, normothermia, and stable glucose homeostasis constitutes the cornerstone of treatment. In neonates with CSVT, acute anticoagulation therapy and, when appropriate, extended anticoagulation are recommended in the absence of contraindications. Routine antithrombotic therapy following arterial ischemic stroke is not recommended because of the low recurrence risk.

CONCLUSIONS

This S2k guideline provides comprehensive recommendations for the diagnosis, treatment, and long-term management of neonatal stroke and CSVT. Early identification of affected infants, appropriate use of advanced neuroimaging, and structured interdisciplinary follow-up are essential to minimize neurological sequelae and improve long-term neurodevelopmental outcomes.