title: Antiphospholipid antibodies in neonates with stroke--a unique entity or variant of antiphospholipid syndrome?
abstract: OBJECTIVE
  YB current affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Israel YB and MJS contributed equally to the study and should be regarded as joint first authors on this manuscript. Antiphospholipid syndrome (APS) may present with thrombosis and persistently elevated titers of antiphospholipid antibodies (aPL) in the neonatal period. Our aim was to investigate the course and impact of elevated titers of aPL in a cohort of infants presenting with either perinatal arterial ischemic stroke (PAS) or cerebral sinus vein thrombosis (CSVT) during the perinatal period.
  
  
  METHODS
  Sixty-two infants with clinically and radiologically confirmed PAS or CSVT presenting in the neonatal period underwent thrombophilia workup that included Factor V Leiden (FVL), PII20210A mutation, MTHFR 677T polymorphism, protein C, protein S, aPL namely either circulating lupus anticoagulant (CLA), anticardiolipin antibodies (aCL) or anti-β2-glycoprotein-1 (β2GP1). Mothers also underwent thrombophilia workup.
  
  
  RESULTS
  Twelve infants with persistently elevated aPL were prospectively followed. Infants with positive aPL showed no concordance with presence of maternal aPL. All children were followed for a median of 3.5 years (range: nine months to 19 years) with repeated aPL testing every three to six months. Anticoagulant therapy initiation and therapy duration varied at the physician's discretion. In 10/12 cases aPL decreased to normal range within 2.5 years; one female with complex thrombophilia risk factors required indefinite prolonged anticoagulation. None of the infants showed recurrent thrombosis or any other APS manifestations, despite lack of prolonged anticoagulation.
  
  
  CONCLUSIONS
  The presence of aPL may be important in the pathogenesis of cerebral thrombosis in neonates. Nevertheless, the nature of thrombophilia interactions in this period and their therapeutic impact warrants further investigation.
authors.affiliation: Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Berkun
authors.affiliation: Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: M J
authors.initials: MJ
authors.lastname: Simchen
authors.affiliation: Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Strauss
authors.affiliation: Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Menashcu
authors.affiliation: Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Padeh
authors.affiliation: Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel Departments of Pediatrics; Obstetrics and Gynecology; Neonatology; Pediatric Neurology; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel Gili.kenet@sheba.health.gov.il.
authors.forename: G
authors.initials: G
authors.lastname: Kenet
mesh_terms: D000293:Adolescent; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000276:immunology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D007557:Israel; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000276:immunology* / Q000517:prevention & control; D020521:Stroke / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000276:immunology* / Q000517:prevention & control; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D015415:Biomarkers
keywords: Anticardiolipin antibodies; PAS; antiphospholipid syndrome; perinatal arterial stroke; pregnancy; thrombosis