Background Perinatal factors (PF) have been implicated in the pathogenesis of PAIS. Hypoxia has been suggested to be involved as a potential cause of AIS although prospective case-control studies are still warranted.

Objective To determine the impact of PF on neonatal cases diagnosed of PAIS in a prospective case-control study.

Methods 45 neonates were diagnosed of PAIS within four weeks of life and 85 controls were investigated for the following PF: retarded intrauterine growth restriction, sentinel event, epidural and general anaesthesia, presentation at delivery, type of delivery (vaginal, instrumental, emergency caesarean section), abnormal cardiotocographic monitoring, Apgar score at 1 and 5 min, arterial umbilical cord pH <7.0 and <7.20, and need of advanced resuscitation.

Results The univariate analysis indicated the following associations with PAIS: emergency caesarean section (48.9% vs 14.8%; p < 0.001); Apgar score at 1 min < 7 (22.2% vs 4.6%; p = 0.005) and < 5 (15.6% vs 1.1%; p = 0.002); arterial cord pH, mean ± SD 7.19 ± 0.12 (CI95% 7.15,7.23) in infants with PAIS compared to 7.25 ± 0.1 (7.23,7.27) in controls (p = .005); arterial cord pH <7.20 (45.2% vs 17.8%; p = 0.006).

A multivariate analysis did not show any independent factor associated to PAIS, except for arterial cord pH < 7.20 (OR 2.89, CI95% 1.01, 8.31). Emergency caesarean section and Apgar score <5 at 1min, showed a tendency to be associated with PAIS but without statistical significance: OR 2.61 (95% CI 0.66, 10.2) and 10.02 (CI95% 0.46, 215.8).

Conclusion Our data indicate that PF do not appear to play a major role in PAIS.