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Time is of the essence when it comes to treating stroke patients. Up to half of adult stroke patients get to hospital within the four-and-a-half hour timeframe required to administer some clot-busting treatments. But what happens when newborns or babies have a stroke?
Mark Mackay, who is establishing studies to measure the true incidence of childhood stroke, says on average it takes 24 hours for stroke to be diagnosed in children and most of the delays occur after they arrive at hospital. By that time, the window for early intervention to prevent lifelong disability from brain injury is firmly closed.
“Children will never benefit from those treatments unless we develop strategies to improve recognition of stroke symptoms in the community, and recognition of stroke by emergency doctors who are seeing these children when they come into hospital,” says Mark.
“The catch cry is ‘time is brain’,” he continues. “Once the symptoms start the clock is ticking. The sooner you can get that patient diagnosed, the sooner you can give the treatment, the better the outcome.”
About three to 10 children per 100,000 will suffer a stroke. One third of these children suffer a stroke before they turn one and half before age five. It’s more common in newborns – those figures are one in 2,500. Stroke is the most common cause of cerebral palsy in children born full-term.
Mark started working as a paediatric neurologist, specialising in epilepsy, more than a decade ago. Within several years, he and his colleagues had recognised the need to develop a dedicated childhood stroke service and a research program in parallel.
“A decade later, we are the second biggest contributor globally to collaborative international research into causes and outcomes from paediatric stroke,” he says.
His doctorate, focusing on developing strategies to increase awareness of stroke and improve the accuracy and timeliness of diagnosis in children, garnered huge international interest. It came after a US-based study to test the safety and effectiveness of clot-busting drug TPA in children was abandoned after 18 months because no children could be recruited to the trial. This was unsurprising to Mark – the children simply weren’t getting to hospital in the required timeframe to be eligible for treatment.
He embarked on research in Australia, interviewing parents, emergency call takers and paramedics, to investigate the delays in getting these children to hospital.
When the study featured at an American Heart Association conference, it notched up 4.6 million hits on the association’s website. It was only a small Australian cohort – 34 parents of 28 childhood stroke patients were interviewed. “Obviously, because nobody had done that research before, it was seen to be very important,” he says.
His study revealed less than half the parents recognised the symptoms of stroke and called an ambulance. “They knew something was seriously wrong with their child. But they didn’t think it was a stroke,” Mark says.
Stroke symptoms in children are the same as adults and include face and arm weakness, and speech interruption. However, babies aged one month and under present with seizures. Two registries are therefore being established, led by the Institute, to look at these different age groups.
Mark is now leading studies to develop information for groups including triage nurses and paediatricians to better recognise symptoms of stroke in children and to diagnose these children using MRI scans, so treatment can be given quickly.
His team is also participating in a US-led international study investigating the causes of stroke in pregnancy and newborns. The medical records of babies who have suffered a stroke will be analysed, along with DNA samples, to explore what led to the stroke and identify any genetic causes.
Mothers will also participate in a questionnaire about their pregnancy and labour. It is hoped the information collected will be used to develop methods to screen women and unborn babies for stroke risk in future.
“The cause of stroke in pregnant women and babies is unknown. This research hopes to understand how often and why these strokes occur.”
Working with childhood stroke patients has its challenges but Mark is satisfied when he can give families relevant information so they have a better understanding as to why their baby had a stroke.
“That’s why I enjoy working here so much,” he says. “You’ve got a world-class research institute combined with a world-class children’s hospital so you can provide the best care to families.”