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

Table 1

Clinical, laboratory, and therapeutic analyses of 21 patients with neonatal thrombosis and antiphospholipid antibodies.

Case	Reference	Sex	Delivery and newborn age	Clinical manifestation	Maternal history	Neonatal antibodies	Treatment	Evolution
1	Finazzi et al. 1987 [4]	F	Preeclampsia cesarean delivery/20 days	Cyanosis in the left foot. US Doppler: left femoral artery thrombosis	Primary APS	Lupus anticoagulant	NR	Death on day 30 due to extensive aortic thrombus (autopsy)
2	Sheridan-Pereira et al. 1988 [5]	F	Cesarean delivery/at birth	DIC and MV.; Absence of distal pulses and cyanosis. Thrombosis of the aorta at the origin of the superior mesenteric artery 32 hours after birth. Central catheter used	Maternal APS	Lupus anticoagulant	Plasmapheresis and heparin	The peripheral pulses were normal on day 13
3	Silver et al. 1992 [6]	NR	Delivery NR/at birth	Right spastic hemiparesis. MRI: middle cerebral artery infarction	Mother with multiple sclerosis and primary APS	NR	NR	Improvement of the hemiparesis at 6 months
4	Contractor et al. 1992 [7]	NR	Cesarean delivery/1 day	Left abdominal mass and hematuria. Renal vein and inferior vena cava thrombosis	Mother with aPL	IgG anti-cardiolipin	NR	Clinical improvement at day 7. The antiphospholipid profile disappeared at 4 months postpartum
5	Tabbutt et al. 1994 [8]	M	Cesarean delivery/3 days	Aortic, left renal artery, middle cerebral and superior sagittal sinus thrombosis, sepsis	Primary APS	Prolonged APTT, aPL negative	Heparin and ATB	Favorable at 2 months
6	Hage et al. 1994 [9]	M	Cesarean delivery/at birth	Hydrops fetalis with renal vein thrombosis	Healthy mother	Lupus anticoagulant	Mother was treated with tocolytic medications	Unfavorable. Fetal death
7	Teyssier et al. 1995 [10]	M	Normal vaginal delivery/3 days	Convulsion due to cerebrovascular ischemia and massive bilateral adrenal hemorrhage	Mother with aPL	Anti-cardiolipin positive	Phenobarbital	Favorable. Normal EEG at 7 months after birth
8	de Klerk et al. 1997 [11]	M	Normal vaginal delivery/at birth	Seizures, blinking repeatedly, spasms on the right side of the head, hand, and foot (no longer than 3 minutes). Ischemic stroke at the level of the left middle cerebral artery	Mother with aPL	Lupus anticoagulant	Phenobarbital	Favorable after 1 year
9	Navarro et al. 1997 [12]	NR	Cesarean delivery/3 days	Respiratory distress syndrome, pneumoperitoneum and abdominal livedo (mesenteric thrombosis)	Primary APS	IgG anti-cardiolipin	NR	Death on day 11 after laparotomy
10	Akanli et al. 1998 [13]	NR	Cesarean delivery/6 hours	Apnea, cyanosis, and moderate hypotonia. Mechanical ventilation. Progressed with stroke in the left middle cerebral artery area	Mother with aPL	IgG anti-cardiolipin	NR	Seizures until 3 years of age
11	Chow and Mellor 2000 [14]	F	Cesarean delivery/48 hours	Focal seizure in the left hemibody. CT: cerebral ischemia	Primary APS	IgG anti-cardiolipin	Phenobarbital and phenytoin	Favorable. Normal neurological examination 5 months after birth
12	Chow and Mellor 2000 [14]	M	Delivery NR/at birth	Right hemiplegia; later developed epilepsy. CT: ischemia at the level of the left middle cerebral artery	Primary APS	NR	NR	Unfavorable. Epilepsy
13	Tuohy and Harrison 2005 [15]	M	Preeclampsia, cesarean delivery/5 days	Anuria, paleness, and absence of pulse in the lower extremities. Aortic thrombosis	Primary APS	IgG anti-cardiolipin	rTPA	Death from renal failure on day 10
14	Soares Rolim et al. 2006 [1]	M	Delivery NR/20 hours	Thrombocytopenia, livedo reticularis; pericardial effusion; subclavian vein and external jugular thrombosis concomitantly with severe respiratory tract/central catheter infection	Secondary APS	IgG and IgM anti-cardiolipin	Immunoglobulin IV heparin and antibiotic treatment	Death
15	Paro-Panjan et al. 2007 [16]	F	Normal vaginal delivery/13 hours	Seizures; ischemic stroke. MRI: occlusion of the left middle cerebral artery	Mother with aPL	IgG anti-cardiolipin. Mutation of the prothrombin gene polymorphism; G20210A and gene polymorphism C677T	Phenobarbital	No neurological deficits after 1 year of follow-up
16	Alshekaili et al. 2010 [17]	M	Normal vaginal delivery/5 days	Reduced spontaneous movement of the right limbs; ischemic stroke of the middle cerebral artery. Epilepsy. Late livedo reticularis (after 4 years)	Healthy mother	IgG anti-cardiolipin, IgG anti B2GPI. Factor V Leiden (G20210A allele)	Antiepileptic and anticoagulant	Favorable
17	Cabral et al. 2011 [18]	M	Normal vaginal delivery/17 days	Irritability, abdominal distension, vomiting, bloody stools with signs of shock, necrotizing enteritis-exploratory laparotomy. ICC: after 13 months, started to exhibit tonic-clonic seizures and right hemiparesis. Stroke in the frontal, parietal, and right temporal lobes	Healthy mother	Lupus anticoagulant, IgG/IgM anti-cardiolipin, IgG and IgM anti-B2GPI.; PT polymorphism 20210G>A and PAI-1 polymorphism 675G>A	Low molecular weight heparin, acetyl salicylic acid, and phenobarbital	Favorable after 5 years of follow-up
18	Bhat et al. 2011 [19]	M	Cesarean delivery/3 days	Sepsis. Bluish discoloration in the left lower limb (thrombosis of the left femoral artery); absence of popliteal pulse and prolonged capillary refill time	Mother with aPL	Lupus anticoagulant	Thrombolysis, urokinase/heparin, and antibiotic	Favorable
19	De Carolis et al. 2012 [20]	M	Normal vaginal delivery/1 day	Severe respiratory distress due to pneumonia. Thrombosis in the superior sagittal sinus	Healthy mother	IgG anti-cardiolipin	NR	Normal neurological development after 1 year
20	Merlin et al. 2012 [21]	M	Normal vaginal delivery/3 days	Right clonic seizures.; MRI showed left middle cerebral artery infarction	Healthy mother	IgG anti-cardiolipin and IgG B2GPI	100 mg of valproate and aspirin every other day	Normal development and neurological examination after 1 year
21	Sousa et al. 2012 [22]	F	Cesarean delivery/8 hours	Focal and multifocal seizures and left hemiparesis. MRI: ischemic stroke	Healthy mother	IgG anti-cardiolipin, IgG B2GPI, and lupus anticoagulant positives (de novo synthesis).; 1298C/C MTHFR and PAI-1 844A/A and 675 4G/4G gene polymorphisms	Anticonvulsants and aspirin	L side body strength improved and monoparesis in the left upper limb persisted after 1 year. Seizures improved at 3 months of age

APS: antiphospholipid syndrome. DIC: disseminated intravascular coagulation. MV: mechanical ventilation. rt-PA: recombinant tissue plasminogen activator. aPL: antiphospholipid antibodies. MRI: magnetic resonance imaging. IV: intravenous. B2GPI: B2-glycoprotein I. PT 20210G>A: heterozygosity for the prothrombin gene. PAI-1 675G>A: homozygosity for the plasminogen activator inhibitor-1 gene. 1298C/C MTHFR: homozygous mutation of the methyltetrahydrofolate reductase gene. PAI-1 844A/A and 675 4G/4G: double heterozygosity for the inhibitor plasminogen activator. C677T: heterozygosity for the methylenetetrahydrofolate reductase gene polymorphism. NR: not reported.