PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1400-1404
Prothrombotic Disorders and Abnormal Neurodevelopmental Outcome in Infants With Neonatal Cerebral Infarction
Received Jun 26, 2000; accepted Dec 4, 2000.
,,
From the * Departments of Paediatrics and 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.
Haematology and the
§ Medical Research Council Clinical Sciences Centre, Imperial College,
Hammersmith Campus, London, United Kingdom.
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