Article Text

MATERNAL THROMBOPHILIA AND NEUROLOGICAL SEQUELAE IN NEWBORNS
  1. L Pogliani1,
  2. A De Palma1,
  3. L Muggiasca2,
  4. D Dilillo1,
  5. L Arrigoni3,
  6. F Meneghin1,
  7. G V Zuccotti1
  1. 1Department of Pediatrics, University of Milan, L Sacco Hospital, Milan, Italy
  2. 2Department of Obstetric and Gynaecology, University of Milan, L Sacco Hospital, Milan, Italy
  3. 3Department of Haematology, L Sacco Hospital, Milan, Italy

Abstract

Background Recent studies provide evidence that genetic thrombotic disorders are significant risk factors for neonatal cerebral haemorrhage/ischaemia.

Methods and Results Four term infants with the diagnosis of stroke/intraventricular haemorrhage (IVH), born from 1 January 2006 to 31 December 2007, were evaluated at our Department of Paediatrics. Both mothers and newborns were studied for genetic and acquired prothrombotic conditions. The table shows the results of maternal/neonatal thrombotic mutations. In three out of four newborns the vascular accident occurred before birth. In particular, ventricular dilatation with IVH was found in two newborns at 34 and 35 weeks of gestational age, respectively, and in the third a Wallerian degeneration of the left hemisphere due to left middle artery occlusion was demonstrated at 4 days of life by magnetic resonance imaging.

Discussion The embolic theory supports the hypothesis that hypercoagulability, carried by either the mother or the fetus, is the cause of abnormal vascular development, vessel occlusion and placental infarctions, which affect the materno–fetal circulation. Our observations, however, suggest that C677T mutations in mothers are greatly associated with neonatal stroke or haemorrhage. Fetal circulation implies that a clot, which has formed in the placenta and migrates, will preferentially embolise through the foramen ovale in the cerebral vasculature.

Pogliani et al

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