Atypical timing and presentation of periventricular haemorrhagic infarction in preterm infants: the role of thrombophilia

Dev Med Child Neurol. 2012 Feb;54(2):140-7. doi: 10.1111/j.1469-8749.2011.04135.x. Epub 2011 Nov 18.

Abstract

Aim: Periventricular haemorrhagic infarction (PVHI) is a complication of preterm birth associated with cardiorespiratory instability. To date, the role of thrombophilia as a possible additional risk factor in infants with atypical timing and presentation of PVHI has not been investigated.

Method: This was a retrospective cohort study of preterm infants who developed PVHI with an atypical timing and presentation either of antenatal onset or late in the postnatal course in the absence of a preceding sudden deterioration of their clinical condition. In infants with atypical PVHI mutation analysis of the factor V Leiden (G1691A), prothrombin (G20210A) gene, and C677T and A1298C polymorphisms in the MTHFR gene was performed, and plasma lipoprotein(a) and homocysteine levels were measured.

Results: Sixty-two preterm infants who presented with a PVHI were studied. Seventeen had an atypical presentation (seven males, 10 females; median birthweight 1170g [range 580-1990g]; median gestational age 30.6wks [range 28.7-33.7wks]). The typical PVHI group comprised 28 males and 17 females (median birthweight 1200g [range 670-2210g]; median gestational age 29.6wks [range 25.3-33.6wks]). Among the 17 infants with atypical presentation, the factor V Leiden mutation was found in seven infants (41%) as well as in the mothers of six of these seven infants; in one infant this was concomitant with a prothrombin gene mutation. A polymorphism in the MTHFR gene was also present in these infants. In two infants with an atypical presentation who were tested for this, a mutation in the COL4A1 gene was found (reported previously). All but two of the infants with an atypical presentation developed spastic unilateral cerebral palsy.

Interpretation: An atypical presentation of PVHI in preterm infants tends to occur more often in the presence of thrombophilia. Testing of thrombophilia, especially factor V Leiden and prothrombin gene mutation, is recommended in these infants.

MeSH terms

  • Cerebral Ventricles / pathology*
  • Cohort Studies
  • Collagen Type IV / genetics
  • Factor V / genetics
  • Female
  • Humans
  • Infant
  • Leukoencephalitis, Acute Hemorrhagic / blood
  • Leukoencephalitis, Acute Hemorrhagic / genetics
  • Leukoencephalitis, Acute Hemorrhagic / physiopathology*
  • Lipoproteins / blood
  • Magnetic Resonance Imaging
  • Male
  • Methylenetetrahydrofolate Reductase (NADPH2) / genetics
  • Neurologic Examination
  • Polymorphism, Genetic / genetics*
  • Premature Birth / diagnosis
  • Premature Birth / genetics
  • Premature Birth / physiopathology*
  • Prothrombin / genetics
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Thrombophilia / genetics
  • Thrombophilia / physiopathology*
  • Time Factors
  • Ultrasonography, Doppler

Substances

  • COL4A1 protein, human
  • Collagen Type IV
  • Lipoproteins
  • factor V Leiden
  • Factor V
  • Prothrombin
  • Methylenetetrahydrofolate Reductase (NADPH2)