Symptomatic Ischemic Stroke in Full-Term Neonates

Günther, Gudrun; Junker, Ralf; Sträter, Ronald; Schobeß, R.; Kurnik, Karin; Kosch, Andrea; Nowak‐Göttl, Ulrike

doi:10.1161/01.str.31.10.2437

Cited by 277 publications

(75 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…20 The prevalence of MTHFR1298 mutation in our study was comparable to the wide range of incidence reported in the United States population. 33 Previous studies have reported an increased prevalence of FVL and MTHFR mutations in neonates and children with thrombosis compared to the general population 16,34 and have also shown an increased risk of catheter-related thrombosis in patients with FVL; 12,13 however, we found no difference in the prevalence of MTHFR mutations and FVL mutation in infants with and without thrombosis.…”

Section: Discussioncontrasting

confidence: 52%

“…12,13 Factor V Leiden (FVL) is the most commonly identified risk factor 14 and has been associated with an increased incidence of both spontaneous and catheter-associated thrombosis. 12,[15][16][17] The risk of spontaneous thrombosis increases eightfold in the heterozygous state, and 80-fold in the homozygous state. 18 Prevalence of heterozygous FVL in the North American Caucasian population is 4 to 6%.…”

Section: Introductionmentioning

confidence: 99%

“…This genetic mutation is present in 1 to 2% of the general population but the prevalence is 4 to 20% in selected high-risk groups such as patients with thrombosis. 20 Methylene-tetrahydrofolate reductase (MTHFR) 677C>T (MTHFR667) and MTHFR1298A>C (MTHFR1298) mutations cause altered MTHFR activity leading to increased plasma levels of homocysteine, 16,[20][21][22] especially in folate-deficient patients. Hyperhomocystenemia has been associated with an increased risk of thrombosis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

et al. 2007

View full text Add to dashboard Cite

Objective: To evaluate the prevalence of hereditary prothrombotic mutations, and their effect on the incidence and severity of umbilical arterial or venous catheter (UAC or UVC)-associated thrombosis.Study Design: All neonates with a UAC or UVC were studied prospectively for the presence, severity and timing of thrombosis with duplex Doppler ultrasound scan. Genetic testing for factor V Leiden (FVL), prothrombin mutation (PTm) and methylene-tetrahydrofolate reductase (MTHFR) mutations was performed using PCR and restriction fragment length polymorphism assays.Result: Umbilical catheter (UC)-associated thrombosis developed in 16/53 (31%) neonates; 23% of UACs and 22% of UVCs were associated with thrombosis. The prevalence of a significant prothrombotic mutation was present in 10/51 (20%) of infants: FVL (8%), MTHFR667 homozygosity (10%), MTHFR1298 homozygosity (2%) and PTm (0%). There was no increase in the risk of UC-associated thrombus in patients carrying these prothrombotic mutations; our study had the power to detect a 2.5-fold increased risk of thrombosis for any of these significant mutations. In addition, MTHFR667 heterozygosity was found in 41% of infants and MTHFR1298 heterozygosity in 52% and also were not associated with increased risk of UC-associated thrombus. The risk of MTHFR double heterozygosity (db het) was 14%, the risk of a significant or db het was 17/51 (33%) and the risk of any mutation was 90%.Conclusion: Prothrombotic genetic mutations are common in our Neonatal Intensive Care Unit population but do not appear to increase the risk of UC-associated thrombosis.

show abstract

Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Factor V Leiden mutation, hyperhomocysteinemia, and elevated lipoprotein(a) levels all have been described with increased frequency in infants with PAS when compared with healthy control subjects. [25][26][27] Previous studies of PAS are subject to a number of important limitations. Most describe only a small number of children 6,7,10,15,24,28 or lack an adequate comparison group to assess the significance of potential risk factors.…”

mentioning

confidence: 99%

Perinatal Stroke in Children With Motor Impairment: A Population-Based Study

et al. 2004

View full text Add to dashboard Cite

ABSTRACT. Objective. Risk factors for perinatal arterial stroke (PAS) are poorly understood. Most previous studies lack an appropriate control group and include only infants with symptoms in the newborn period. We set out to determine prenatal and perinatal risk factors for PAS.Methods. In a population-based, case-control study nested within the cohort of 231 582 singleton infants who were born at >36 weeks' gestation in Northern California Kaiser hospitals from 1991 to 1998, we searched electronically for children with motor impairment and reviewed their medical records to identify diagnoses of PAS. Control subjects were randomly selected from the study population. A medical record abstractor reviewed delivery records without knowledge of case status.Results. The prevalence of PAS with motor impairment was 17/100 000 live births. Of 38 cases, 26 (68%) presented after 3 months of age with hemiparesis or seizures. All 12 newborns with acute stroke symptoms had seizures. A delayed presentation was more common in children with moderate to severe motor impairment than among infants with only mild motor abnormalities (24 of 31 vs 2 of 7). Prepartum risk factors significantly associated with PAS in multivariate analysis were preeclampsia (odds ratio [OR]: 3.6; 95% confidence interval [CI]: 1.1-11.4) and intrauterine growth restriction (OR: 5.3; 95% CI: 1.5-18.6). Newborns with PAS were also at higher risk of delivery complications, such as emergency cesarean section (OR: 6.8; 95% CI: 2.7-16.6), 5-minute Apgar <7 (OR: 23.6; 95% CI: 4.1-237), and resuscitation at birth (OR: 4.5; 95% CI: 1.6 -12.3).Conclusions. Preeclampsia and intrauterine growth restriction (IUGR) may be independent risk factors for perinatal stroke resulting in motor impairment. Large multicenter studies that include all children with perinatal stroke are needed to determine further the risk factors and outcome of perinatal stroke. Pediatrics 2004;114:612-619; perinatal stroke, epidemiology, neonate, infarction, cerebral palsy.

show abstract

“…6,37 Other hematological disturbances associated with pediatric stroke include iron-deficiency anemia 11,38 and polycythemia. 39 In neonates, peripartum factors such as preeclampsia, prolonged rupture of membranes, and placental abnormalities are risks. 6,40 In older children, metabolic disorders may produce stroke or stroke-like episodes including MELAS, 41 Fabry disease, 42 and hyperhomocysteinemia.…”

Section: Risk Factors and Pathophysiologymentioning

confidence: 99%

Therapeutic approaches and advances in pediatric stroke

Kirton

deVeber

2006

NeuroRX

View full text Add to dashboard Cite

Summary:Evidence-based therapeutic interventions for pediatric ischemic cerebrovascular disease are beginning to emerge. The primary therapeutic target is usually the pathological prothrombotic disturbance that underlies the majority of pediatric stroke. A battle between anticoagulation and anti-platelet therapies continues to provide controversy and is the inspiration for upcoming randomized trials. Supportive care and neuroprotective strategies are an important consideration in children with stroke. Attempts to determine the safety of acute thrombolytic interventions are also underway. Finally, unique medical and surgical treatments for specific diseases leading to stroke in children continue to evolve. After briefly summarizing the epidemiology, pathophysiology, diagnosis, and outcomes of ischemic strokes in children, treatment approaches and alternatives will be reviewed in detail with emphasis placed on current areas of controversy and future directions for clinical research.

show abstract

Symptomatic Ischemic Stroke in Full-Term Neonates

Cited by 277 publications

References 48 publications

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

Perinatal Stroke in Children With Motor Impairment: A Population-Based Study

Therapeutic approaches and advances in pediatric stroke

Contact Info

Product

Resources

About