De novo neonatal antiphospholipid syndrome: a case report and review of the literature.
OBJECTIVE
Neonatal antiphospholipid syndrome (APS) is rare and only few cases have been reported, most of them describing trans-placental passage of penetrable maternal antibodies. The current article aims at defining the clinical and biochemical features of the de novo occurrence of neonatal APS and considerations for long-term treatment.


METHODS
We present a case and review the medical literature using PubMed.


RESULTS
Including the current report, there are 11 reports of de novo neonatal APS. These include 8 cases of acute ischemic stroke, 2 of venous thrombosis, and 1 of mixed arterial and venous thrombosis. All cases had an additional thrombotic risk factor, either inherited or acquired. Negative maternal history together with low clinical suspicion led to late diagnosis in most cases. In all cases aPL antibodies persisted in the serum throughout the follow-up period. No recurrence of thrombotic events was reported in patients under long-term anticoagulation with either low-molecular-weight heparin (LMWH) or aspirin. There is 1 report of recurrent thrombosis where the patient did not receive anticoagulation. In this case diagnosis was made only retrospectively after recurrence.


CONCLUSIONS
We recommend that de novo APS be considered in all cases of unexplained neonatal thrombosis aiming at early diagnosis and implementation of long-term anticoagulation to prevent recurrent thrombotic events.
Department of Pediatric, Hadassah Hebrew-University Hospital, Ein-Kerem Campus, Jerusalem 91120, Israel. Electronic address: orengo@hadassah.org.il.
Oren
O
Gordon
Department of Pediatric, Hadassah Hebrew-University Hospital, Ein-Kerem Campus, Jerusalem 91120, Israel.
Yotam
Y
Almagor
Department of Pediatric, Hadassah Hebrew-University Hospital, Ein-Kerem Campus, Jerusalem 91120, Israel.
Dvora
D
Fridler
Pediatric Intensive Care Unit, Hadassah Hebrew-University Hospital, Jerusalem, Israel.
Asaf
A
Mandel
Department of Pediatric, Hadassah Hebrew-University Hospital, Ein-Kerem Campus, Jerusalem 91120, Israel.
Hiba
H
Qutteineh
Department of Pediatric Hematology/Oncology, Hadassah Hebrew-University Hospital, Jerusalem, Israel.
Asaf
A
Yanir
Department of Pediatric, Hadassah Hebrew-University Hospital, Ein-Kerem Campus, Jerusalem 91120, Israel.
Shimon
S
Reif
Department of Pediatric Hematology/Oncology, Hadassah Hebrew-University Hospital, Jerusalem, Israel.
Shoshana Revel
SR
Vilk
D017152:Antibodies, Antiphospholipid / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D008297:Male; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants
Antiphospholipid syndrome; Neonatal thrombosis