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Prothrombotic disorders and abnormal neurodevelopmental outcome in infants with neonatal cerebral infarction
1Departments of Paediatrics, Imperial College, Hammersmith Campus, London, United Kingdom. emercuri@ic.ac.uk
Insights
Prothrombotic disorders, including factor V Leiden, are common in infants with neonatal stroke. These factors are linked to cerebral hemorrhage and poor neurological outcomes.
Area of Science:
- Pediatric Neurology
- Hematology
- Neonatal Medicine
Background:
- Neonatal stroke is a significant cause of long-term disability.
- Prothrombotic disorders are implicated in adult stroke but less understood in neonates.
- Identifying risk factors is crucial for predicting outcomes in neonatal stroke.
Purpose of the Study:
- To determine the prevalence of prothrombotic disorders in infants with neonatal stroke.
- To investigate the association between these disorders and MRI findings (infarct type, hemorrhage).
- To explore the link between prothrombotic disorders and clinical outcomes.
Main Methods:
- Study included 24 infants diagnosed with perinatal cerebral infarction via MRI.
- Genetic and acquired prothrombotic disorders were assessed in infants and parents.
- Clinical data and neurological outcomes were systematically collected.
Main Results:
- 42% of infants had at least one prothrombotic risk factor.
- Factor V Leiden heterozygosity (5 infants) and high factor VIIIc (6 infants) were identified.
- Prothrombotic factors were strongly associated with cerebral hemorrhage and poor neurological outcomes (hemiplegia, developmental delay).
Conclusions:
- Prothrombotic risk factors, especially factor V Leiden, are prevalent in neonatal stroke.
- These factors significantly correlate with adverse neurological outcomes.
- Early identification of prothrombotic disorders may aid in risk stratification and management.
Background And Purpose:
The aim of this study was to evaluate the occurrence of prothrombotic disorders in a well-characterized cohort of infants with neonatal stroke and to document any association of prothrombotic disorders with the type of infarct seen on magnetic resonance imaging (MRI) and clinical outcome.
Methods:
Twenty-four infants with perinatal cerebral infarction confirmed by neonatal MRI were enrolled in the study. All the infants and, when possible, both parents were tested to identify inherited and acquired prothrombotic disorders.
Results:
None of the infants had a significant bleeding diathesis, but 10 (42%) had at least 1 prothrombotic risk factor. Five children showed heterozygosity for factor V Leiden, and 6 had high factor VIIIc concentrations. There was a striking association between the occurrence of these abnormalities and both the presence of cerebral hemorrhage on MRI and poor neurologic outcome. Eight of the 11 patients (73%) with hemiplegia or global developmental delay had factor V Leiden and/or raised factor VIIIc, whereas only 1 of the 13 patients (8%) with normal outcome had any prothrombotic risk factors. In particular, all 5 infants with factor V Leiden had hemiplegia, compared with only 4 of the 19 infants without factor V Leiden (21%).
Conclusions:
These data suggest that the presence of prothrombotic risk factors and, in particular, of the factor V Leiden mutation, is significantly associated with poor outcome after perinatal cerebral infarction.