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Placental Pathology in Neonatal Stroke: A Retrospective Case-Control Study.
Bernson-Leung, Miya E; Boyd, Theonia K; Meserve, Emily E; Danehy, Amy R; Kapur, Kush; Trenor, Cameron C; Lehman, Laura L; Rivkin, Michael J.
Afiliação
  • Bernson-Leung ME; Department of Neurology, Boston Children's Hospital, Boston, MA; Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA.
  • Boyd TK; Department of Pathology, Boston Children's Hospital, Boston, MA; Department of Pathology, Brigham and Women's Hospital, Boston, MA.
  • Meserve EE; Department of Pathology, Brigham and Women's Hospital, Boston, MA.
  • Danehy AR; Department of Radiology, Boston Children's Hospital, Boston, MA.
  • Kapur K; Department of Neurology, Boston Children's Hospital, Boston, MA.
  • Trenor CC; Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA; Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA.
  • Lehman LL; Department of Neurology, Boston Children's Hospital, Boston, MA; Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA.
  • Rivkin MJ; Department of Neurology, Boston Children's Hospital, Boston, MA; Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA; Department of Pathology, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Bo
J Pediatr ; 195: 39-47.e5, 2018 04.
Article em En | MEDLINE | ID: mdl-29397159
OBJECTIVE: To assess the association of placental abnormalities with neonatal stroke. STUDY DESIGN: This retrospective case-control study at 3 academic medical centers examined placental specimens for 46 children with neonatal arterial or venous ischemic stroke and 99 control children without stroke, using a standard protocol. Between-group comparisons used χ2 and Fisher exact t test. Correlations used Spearman correlation coefficient. RESULTS: Case placentas were more likely than controls to meet criteria for ≥1 of 5 major categories of pathologic abnormality (89% vs 62%; OR, 5.1; 95% CI, 1.9-14.0; P = .0007) and for ≥2 categories (38% vs 8%; OR, 7.3; 95% CI, 2.9-19.0; P < .0001). Fetal vascular malperfusion occurred in 50% of cases and 17% of controls (OR, 4.8; 95% CI, 2.2-10.5; P = .0001). Amniotic fluid inflammation occurred in 46% of cases with arterial ischemic stroke vs 25% of controls (OR, 2.6; 95% CI, 1.1-6.1; P = .037). There was evidence of a "stress response" (meconium plus elevated nucleated red blood cells) in 24% of cases compared with 1% of controls (OR, 31; 95% CI, 3.8-247.0; P < .0001). CONCLUSIONS: Placental abnormality was more common in children with neonatal stroke compared with controls. All placental findings represent subacute-to-chronic intrauterine stressors. Placental thrombotic processes were associated with both arterial and venous stroke. Our findings provide evidence for specific mechanisms that may predispose to acute perinatal stroke. Amniotic fluid inflammation associated with neonatal arterial ischemic stroke deserves further investigation.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Placenta / Doenças Placentárias / Acidente Vascular Cerebral Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Female / Humans / Newborn / Pregnancy Idioma: En Revista: J Pediatr Ano de publicação: 2018 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Placenta / Doenças Placentárias / Acidente Vascular Cerebral Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Female / Humans / Newborn / Pregnancy Idioma: En Revista: J Pediatr Ano de publicação: 2018 Tipo de documento: Article País de publicação: Estados Unidos