Neonatal Middle Cerebral Artery Infarction: Association with Elevated Maternal Anticardiolipin Antibodies

Akanli, L.; Trasi, S. S.; Thuraisamy, Kalpna; Bergtraum, Marcia P.; Thantu, Annabella; Fischer, Rita F.; Cohen-Addad, Nicole

doi:10.1055/s-2007-993965

Cited by 37 publications

(14 citation statements)

References 12 publications

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“…In contrast, our study, which included only those children with persistent, significant APA positivity, found very low prevalence rates and no association with specific perinatal stroke disease states. The role of maternal APAs is less clear; however, the few studies suggesting an association 29,[43][44][45][46][47] have the same limitations described earlier in this section, and the single best acute case-control study in NAIS found no association with APA. 33 That maternal APA positivity has been disassociated from infant positivity in NAIS, 42 and that it is not readily apparent how maternal thrombophilia would lead to cerebral thromboembolism in the fetus or newborn, further calls into question the relevance of maternal APA status.…”

Section: Discussionmentioning

confidence: 99%

Thrombophilia risk is not increased in children after perinatal stroke

Curtis

Mineyko

Massicotte

et al. 2017

Blood

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Key Points• Thrombophilia in children with perinatal stroke is rare, with rates similar to those in the normal population.• Routine testing in childhood is not indicated.Perinatal stroke causes cerebral palsy and lifelong disability. Specific diseases are definable, but mechanisms are poorly understood. Evidence suggests possible associations between arterial perinatal stroke and prothrombotic disorders, but population-based, controlled, disease-specific studies are limited. Understanding thrombophilia in perinatal stroke informs pathogenesis models and clinical management.We conducted a population-based, prospective, case-control study to determine the association of specific perinatal stroke diseases with known thrombophilias. Children with idiopathic magnetic resonance imaging-classified neonatal arterial ischemic stroke (NAIS), arterial presumed perinatal ischemic stroke (APPIS), or fetal periventricular venous infarction (PVI) were recruited. Standardized thrombophilia evaluations were performed after 12 months of age on stroke cases and controls, including quantified proteins C and S, antithrombin, factors VIII/IX/XI, fibrinogen, lipoprotein(a), homocysteine, lupus anticoagulant, anticardiolipin antibodies and genotyping of factor V Leiden (FVL), factor II G20210A (FII), and methylenetetrahydrofolate reductase C677T. A total of 212 children were studied: 46 with NAIS, 34 with APPIS, 55 with PVI, and 77 controls (male, 53%; median age, 4.8 years). Of 14 parameters, no differences were observed in 12, including all common thrombophilias. Mean prothrombin time was shorter in arterial strokes (P < .001). Rates of antiphospholipid antibodies were low, comparable to those in controls, and resolved on repeat testing. FVL and FII rates were comparable to population norms. Total number of possible abnormalities did not differ between cases and controls. Our prospective, population-based, controlled, disease-specific study suggests minimal association between perinatal stroke and thrombophilia. This does not exclude the possibility of disordered coagulation at the time of stroke but suggests testing in childhood is not indicated. (Blood. 2017;129(20):2793-2800 Medscape Continuing

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Section: Discussionmentioning

confidence: 99%

Thrombophilia risk is not increased in children after perinatal stroke

Curtis

Mineyko

Massicotte

et al. 2017

Blood

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“…Of the 21 cases reported, 9 mothers had APS and among them, 1 developed SLE after pregnancy and another was diagnosed with APS only because of the clinical manifestations observed in her newborn [1, 2]. Despite having no history of thrombotic events, 6 other case reports demonstrated positivity of at least 1 antiphospholipid antibody; these 6 mothers were healthy, which suggests the de novo production of antiphospholipid antibodies by the neonates [7, 9–11, 13, 16–22]. Within the case reports, anti-cardiolipin antibody appeared to be the most common disease-associated antibody, and its presence was detected in 62% of the newborns.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Laboratory, and Therapeutic Analyses of 21 Patients with Neonatal Thrombosis and Antiphospholipid Antibodies: A Literature Review

Peixoto

Carvalho²,

Rodrigues

2014

Journal of Immunology Research

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Objectives. A review of the literature reports neonatal thrombosis and antiphospholipid antibodies cases through a retrospective study that focuses on the pathogenesis and main clinical and laboratory manifestations of this disease. Methods. The case reports were selected from PubMed. The keywords used to search were neonatal, antiphospholipid syndrome, thrombosis, and antiphospholipid antibodies. References that were published from 1987 to 2013 were reviewed. Results. Twenty-one cases of neonatal thrombosis and antiphospholipid antibodies were identified. Ten children were born preterm (before 37 weeks). Arterial involvement (17/21) was predominant, of which stroke (12/17) was the most prevalent clinical manifestation. Anti-cardiolipin antibodies were predominant (13/21) in the antiphospholipid antibody profiles. Treatments were based on the use of symptomatics such as antiepileptics (8/21), and 6/21 patients received heparin. There were 4 deaths (4/21); otherwise, the children recovered well, especially the neonates who suffered from strokes (9/12). Conclusion. Neonatal thrombosis and antiphospholipid antibodies are rare. The development of thrombotic manifestations in neonates seems not to be associated exclusively with the aPL, but their etiology may be linked to pre- and perinatal events. We noted good therapeutic responses, especially in stroke patients, who presented with favorable outcomes in 82% of the cases.

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“…20 Nevertheless, transplacental passage of pathogenic maternal antibodies has been implicated in some cases when the thrombotic event has occurred in the first 6 months of life and when the autoantibody is of IgG isotype. 9,10,12,13,21,22 However, few if any of these studies have provided the necessary maternal and neonatal serology to reach this conclusion with certainty. Alternatively, autoimmunity in early life is sometimes mediated by de novo production of IgM antibodies that form the early antibody repertoire when the diversity of VDJ recombination is restricted.…”

Section: Discussionmentioning

confidence: 99%

De novo infantile primary antiphospholipid antibody syndrome

Alshekaili

Reynolds

Cook

2010

Lupus

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Most autoimmune diseases are rare in infants. Early onset can represent an extreme phenotype arising from strong genetic predisposition relatively independent of environmental influence. Alternatively, neonatal autoimmunity can arise from transplacental passage of maternal pathogenic IgG autoantibodies. Distinguishing between these possible explanations is crucial for determining the prognosis in the specific patient, and has important implications for understanding pathogenesis. We report a case of neonatal thrombotic stroke associated with both cardiolipin and β2-glycoprotein I antibodies in neonatal serum but absent from cord blood and maternal serum. While the child also carried one prothrombotic allele of factor V (Leiden allele), which may have contributed to the risk of thromboembolic disease, the serological analysis represents unequivocal evidence of de novo neonatal primary phospholipid antibody syndrome.

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Neonatal Middle Cerebral Artery Infarction: Association with Elevated Maternal Anticardiolipin Antibodies

Cited by 37 publications

References 12 publications

Thrombophilia risk is not increased in children after perinatal stroke

Thrombophilia risk is not increased in children after perinatal stroke

Clinical, Laboratory, and Therapeutic Analyses of 21 Patients with Neonatal Thrombosis and Antiphospholipid Antibodies: A Literature Review

De novo infantile primary antiphospholipid antibody syndrome

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