Department of Neurology, Boston Children's Hospital, Boston, MA; Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA.
Department of Pathology, Boston Children's Hospital, Boston, MA; Department of Pathology, Brigham and Women's Hospital, Boston, MA.
J Pediatr. 2018 Apr;195:39-47.e5. doi: 10.1016/j.jpeds.2017.11.061. Epub 2018 Feb 1.
To assess the association of placental abnormalities with neonatal stroke.
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 χ and Fisher exact t test. Correlations used Spearman correlation coefficient.
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).
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.
评估胎盘异常与新生儿卒中的关系。
本研究在 3 所学术医疗中心开展，采用标准方案对 46 名患有新生儿动脉或静脉缺血性卒中的患儿和 99 名无卒中对照患儿的胎盘标本进行回顾性病例对照研究。组间比较采用 χ2 和 Fisher 确切检验。相关性采用 Spearman 相关系数。
与对照组相比，病例组的胎盘更有可能符合 5 种主要病理异常类别的标准之一（89% vs 62%；比值比，5.1；95%置信区间，1.9-14.0；P=0.0007）和≥2 种类别（38% vs 8%；比值比，7.3；95%置信区间，2.9-19.0；P<.0001）。胎儿血管灌注不良在 50%的病例中发生，而在 17%的对照组中发生（比值比，4.8；95%置信区间，2.2-10.5；P=0.0001）。动脉缺血性卒中患儿的羊水炎症发生率为 46%，对照组为 25%（比值比，2.6；95%置信区间，1.1-6.1；P=0.037）。与对照组的 1%相比，有 24%的病例存在“应激反应”（胎粪加核红细胞升高）（比值比，31；95%置信区间，3.8-247.0；P<.0001）。
与对照组相比，新生儿卒中患儿的胎盘异常更常见。所有胎盘发现均代表亚急性至慢性宫内应激源。胎盘血栓形成过程与动脉和静脉卒中均相关。我们的研究结果为可能导致急性围生期卒中的特定机制提供了证据。与新生儿动脉缺血性卒中相关的羊水炎症值得进一步研究。
