Recent Advances in Obstetrics and Perinatal Medicine

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (1 December 2023) | Viewed by 11801

Special Issue Editors


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Guest Editor
Neonatology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
Interests: neonatology; neonatal intensive care; twins; neonatal resuscitation; simulation; human milk; neurological and sensorial neonatal outcome; neonatal screening; medical training; head ultrasound; antenatal corticotherapy

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Guest Editor
Neonatology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Interests: neonatology; perinatology; neonatal point of care ultrasound; medical malpraxis; healthcare quality management

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Guest Editor
Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
Interests: perinatology; ultrasound in obstetrics and gynecology; fetal medicine

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Guest Editor
Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
Interests: prenatal diagnosis; fetal ultrasound; fetal therapy; preeclampsia; fetal growth restriction; endometriosis; laparoscopy
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Special Issue Information

Dear Colleagues,

Research in high-risk pregnancies has increased in recent years, being highlighted and treated by obstetricians, perinatologists, and neonatologists, with the contribution of co-related specialties involved in the care of mothers and newborns. Assisted reproductive techniques, progress in neonatal care, and widespread guidelines and protocols both in obstetrics and neonatology have contributed to decreasing the limit of viability to 22 weeks’ gestation in developed countries and 24-26 weeks’ gestation in low-income countries. This is a significant development; however, a real burden is placed on the individual, their family, and the healthcare and social systems in low-income countries, considering that the long-term outcome of neonates from a high-risk pregnancy may be impaired by severe sequels.

This Special Issue aims to gather scientific evidence relating to care of the mother and child, according to recent advances in their quality of their life, with a focus on interdisciplinary teamwork, from conception to the later neurodevelopment of a child. We welcome all researchers to take part in this effort and share their experience and novel and ongoing research through this Special Issue.

Please visit the Instructions for Authors before submitting a manuscript (https://www.mdpi.com/journal/children/instructions). We welcome your submission.

Prof. Dr. Luminita Paduraru
Prof. Dr. Simona Vladareanu
Dr. Demetra Socolov
Prof. Dr. Dragos Nemescu
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • newborn
  • obstetrics
  • multiple pregnancies
  • prematurity
  • screening in neonatology
  • neurodevelopmental follow-up
  • neonatal intensive care
  • limits of viability
  • congenital malformation
  • assisted reproduction techniques
  • high-risk pregnancy

Published Papers (9 papers)

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Research

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16 pages, 762 KiB  
Article
The Role of Erythropoietin in Preventing Anemia in the Premature Neonate
by Oana Cristina Costescu, Eugen Radu Boia, Marioara Boia, Daniela Mariana Cioboata, Florina Marinela Doandes, Nicoleta Lungu, Mihai Dinu, Emil Radu Iacob and Aniko Maria Manea
Children 2023, 10(12), 1843; https://doi.org/10.3390/children10121843 - 24 Nov 2023
Viewed by 948
Abstract
Recombinant human erythropoietin (rhEPO) treatment is an alternative to red blood cell (RBC) transfusions in neonates presenting anemia of prematurity (AOP). This study assesses the impact of early rhEPO administration on AOP (any stage) incidence, as well as the incidence of individual AOP [...] Read more.
Recombinant human erythropoietin (rhEPO) treatment is an alternative to red blood cell (RBC) transfusions in neonates presenting anemia of prematurity (AOP). This study assesses the impact of early rhEPO administration on AOP (any stage) incidence, as well as the incidence of individual AOP stages and RBC transfusions. Out of 108 preterm neonates, 49 were administered rhEPO and compared to the remaining group using univariate and multivariate analyses. Univariately, gestational age (GA), birth weight (BW), hemoglobin (Hb), hematocrit (HCT), RBC levels, and iron administration were significantly associated with AOP (p < 0.05 each); however, only the latter remained significant following multivariate analysis (AOR: 2.75, 95% CI, 1.06–7.11). Multinomial analysis revealed rhEPO treatment was associated with a near three-fold reduction in moderate AOP incidence (OR: 0.36, 95% CI, 0.15–0.89). Furthermore, ANCOVA revealed positive correlations between rhEPO administration and 21-day Hb (p < 0.01), HCT (p < 0.05), and EPO (p < 0.001) levels. The results confirm previously reported benefits of rhEPO treatment, such as reduced moderate AOP incidence and increased Hb, HCT, and serum EPO levels. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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12 pages, 1002 KiB  
Article
The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis’s Presence and Severity in Malnourished Infants—A Single Center Experience
by Alina Emilia Domnicu, Eugen Radu Boia, Mirela Mogoi, Aniko-Maria Manea, Tamara Marcela Marcovici, Otilia Mărginean and Marioara Boia
Children 2023, 10(10), 1616; https://doi.org/10.3390/children10101616 - 28 Sep 2023
Cited by 1 | Viewed by 1373
Abstract
Sepsis represents one of the leading causes of death in newborns and infants, and prompt diagnosis is essential for achieving favorable outcomes. Regarding malnourished children with concurrent infection, most studies have focused, besides blood culture, on C-reactive protein and procalcitonin. Because malnutrition has [...] Read more.
Sepsis represents one of the leading causes of death in newborns and infants, and prompt diagnosis is essential for achieving favorable outcomes. Regarding malnourished children with concurrent infection, most studies have focused, besides blood culture, on C-reactive protein and procalcitonin. Because malnutrition has a deleterious effect on cellular immune competence, the present study characterized the acute-phase response, including hematological indices, in response to sepsis. Among the examined laboratory biomarkers, procalcitonin and neutrophil-to-lymphocyte ratio were the most accurate discriminators between sepsis patients and those with bacterial infection. Moreover, these two parameters showed a gradual increase between sepsis, severe sepsis, and septic shock patients (p < 0.001). Subgroup analysis of the sepsis group revealed positive correlations of NLR with prolonged ICU stay (<0.001), acute organ dysfunction (0.038), mechanical ventilation (<0.001), and fatality (<0.001). In summary, our results suggest that the neutrophil-to-lymphocyte ratio can be used as an auxiliary diagnostic index in discriminating the presence and severity of bacterial sepsis in malnourished infants. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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12 pages, 246 KiB  
Article
Lipid Profile Variations in Pregnancies with and without Cardiovascular Risk: Consequences for Both Mother and Newborn
by Simona-Alina Abu-Awwad, Marius Craina, Lioara Boscu, Elena Bernad, Paula Diana Ciordas, Catalin Marian, Mircea Iurciuc, Ahmed Abu-Awwad, Stela Iurciuc, Brenda Bernad, Diana Maria Anastasiu Popov and Anca Laura Maghiari
Children 2023, 10(9), 1521; https://doi.org/10.3390/children10091521 - 07 Sep 2023
Viewed by 892
Abstract
Background: Maternal cardiovascular risk and its implications can have significant repercussions for both the mother and the child. This study compares the lipid profiles of two distinct groups of pregnant women, those with and without cardiovascular risk, to shed light on its [...] Read more.
Background: Maternal cardiovascular risk and its implications can have significant repercussions for both the mother and the child. This study compares the lipid profiles of two distinct groups of pregnant women, those with and without cardiovascular risk, to shed light on its effects on maternal and outcomes for newborns. Materials and Methods: This study enrolled 86 pregnant women, dividing them into two groups: Group 1 (n = 46, healthy pregnancies) and Group 2 (n = 40, pregnancies with cardiovascular risk factors). The data collected included maternal demographics, smoking history, pre-existing pathologies, and a range of laboratory measures. Neonatal outcomes were also recorded. Results: Group 2 showed a significant increase in the percentage of newborns with abnormal APGAR scores (p-value < 0.0001), congenital abnormalities (p-value < 0.0001), severe prematurity (p-value < 0.0001), and neonatal mortality rates (p-value < 0.0001), as well as differences in birth weight (p-value = 0.0392) and therapy usage (surfactant: p-value < 0.001, steroids p-value = 0.004, and antibiotics p-value < 0.001). Regarding laboratory measures, Group 2 exhibited significantly elevated levels of total cholesterol, LDL-C (p-value < 0.0001), ApoB (p-value < 0.0001), Lp(A) (p-value = 0.0486), triglycerides (p-value < 0.0001), and hs-CRP (p-value = 0.0300). Discussion: These results underscore the elevated risk associated with pregnancies complicated by cardiovascular risk factors. Group 2 demonstrated a more concerning clinical profile, with a higher prevalence of detrimental neonatal outcomes and different lipid and inflammatory profiles, signifying a potential pathophysiological link. Conclusions: The differential lipid profiles and adverse neonatal outcomes in pregnancies with cardiovascular risks highlight the urgency of effective risk stratification and management strategies in this population. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
14 pages, 4485 KiB  
Article
Comparative Analysis of Hematological and Biochemical Changes in Neonates among Women with and without COVID-19 Infection during Pregnancy
by Daniela-Eugenia Popescu, Simona Cerbu, Ioana Rosca, Nicoleta Lungu, Ana Adriana Trușculescu, Valerica Belengeanu, Aniko Maria Manea, Mirabela Adina Dima, Florin Gorun, Zoran Laurentiu Popa, Doru Ciprian Crisan and Marioara Boia
Children 2023, 10(8), 1370; https://doi.org/10.3390/children10081370 - 10 Aug 2023
Viewed by 997
Abstract
The aim of this study is to evaluate the test results of neonates delivered by COVID-19-positive mothers during pregnancy with those of neonates born to unvaccinated mothers who are COVID-19-free. A cohort study was conducted on 367 pregnant women who gave birth at [...] Read more.
The aim of this study is to evaluate the test results of neonates delivered by COVID-19-positive mothers during pregnancy with those of neonates born to unvaccinated mothers who are COVID-19-free. A cohort study was conducted on 367 pregnant women who gave birth at Premiere Hospital, Timisoara, Romania, between May 2021 and February 2022. Two groups were established: Group 1, with 167 pregnant women infected with COVID-19, and Group 2, with 200 pregnant women who were not affected by COVID-19 during pregnancy. Maternal laboratory examination did not exhibit significant variations except for platelet count. In neonatal blood tests, WBC had a significantly lower median value in the group born to COVID-19-free mothers. Neonatal anemia and leukocytosis showed slightly higher prevalence in Group 1, but the differences were not statistically significant. This study suggests that maternal COVID-19 infection during pregnancy does not have significant associations with most maternal and neonatal characteristics. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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14 pages, 1658 KiB  
Article
Hematologic Risk Factors for the Development of Retinopathy of Prematurity—A Retrospective Study
by Gabriela Ildiko Zonda, Raluca Mogos, Alina-Sînziana Melinte-Popescu, Ana-Maria Adam, Valeriu Harabor, Dragos Nemescu, Demetra Socolov, Anamaria Harabor, Marian Melinte-Popescu, Maura Adelina Hincu, Ingrid-Andrada Vasilache, Alexandru Carauleanu, Gigi Adam and Luminita Paduraru
Children 2023, 10(3), 567; https://doi.org/10.3390/children10030567 - 16 Mar 2023
Cited by 3 | Viewed by 1110
Abstract
(1) Background: Retinopathy of prematurity (ROP) can cause severe visual impairment or even blindness. We aimed to assess the hematological risk factors that are associated with different stages of ROP in a cohort of preterm newborns, and to compare the clinical characteristics and [...] Read more.
(1) Background: Retinopathy of prematurity (ROP) can cause severe visual impairment or even blindness. We aimed to assess the hematological risk factors that are associated with different stages of ROP in a cohort of preterm newborns, and to compare the clinical characteristics and therapeutic interventions between groups. (2) Methods: This retrospective study included 149 preterm newborns from a tertiary maternity hospital in Romania between January 2018 and December 2018, who were segregated into: Group 1 (with ROP, n = 59 patients), and Group 2 (without ROP, n = 90 patients). The patients that were affected by ROP were subsequently divided into the following subgroups: Subgroup 1 (Stage 1, n = 21), Subgroup 2 (Stage 2, n = 35), and Subgroup 3 (Stage 3, n = 25). The associations were analyzed using multivariate logistic regression and sensitivity analysis. (3) Results: Platelet mass indexes (PMI) that were determined in the first, seventh, and tenth days of life were significantly associated with Stage 1 ROP. PMI determined in the first day of life was also significantly associated with Stage 2 ROP. The sensitivity and specificity of these parameters were modest, ranging from 44 to 57%, and 59 to 63%. (4) Conclusions: PMI has a modest ability to predict the development of ROP. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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12 pages, 1866 KiB  
Article
Assessing the Utility of Hemoglobin, HALP Score, FAR Ratio, and Coagulation Parameters as Predictors for Preterm Birth
by Ingrid Hrubaru, Andrei Motoc, Catalin Dumitru, Felix Bratosin, Roxana Manuela Fericean, Satish Alambaram, Ioana Mihaela Citu, Gratiana Nicoleta Chicin, Izabella Erdelean, Florin Gorun, Cosmin Citu and Zoran Laurentiu Popa
Children 2023, 10(3), 527; https://doi.org/10.3390/children10030527 - 08 Mar 2023
Cited by 2 | Viewed by 1329
Abstract
Premature birth is a worldwide health issue, posing a high mortality risk for newborns, as well as causing emotional and financial difficulties, and long-term health issues for patients. Identifying effective predictors for preterm birth is essential for prolonging gestation or improving obstetric care. [...] Read more.
Premature birth is a worldwide health issue, posing a high mortality risk for newborns, as well as causing emotional and financial difficulties, and long-term health issues for patients. Identifying effective predictors for preterm birth is essential for prolonging gestation or improving obstetric care. As invasive methods are costly, risky, and not universally available, we aim to assess the predictive capacity of various serum parameters in pregnant women during the third trimester, as a non-invasive alternative. Based on previous studies, it was hypothesized that hemoglobin, the association of hemoglobin, albumin, lymphocyte, and platelets’ (HALP) score, and coagulation parameters such as the prothrombin time (PT), activated partial thromboplastin clotting time (aPTT), D-dimers, and fibrinogen to albumin ratio (FAR) have significant prediction capabilities. With a retrospective design, a total of 161 patients with a history of preterm birth were included in the analysis, being matched 1:1 with a control group of women who gave birth at term. All laboratory samples were collected during the third trimester of pregnancy. The computed area under the curve (AUC) ranged between 0.600 and 0.700 in all six studied parameters, suggesting a fair discrimination. The highest predictive value for preterm birth was observed to be represented by the HALP score with AUC = 0.680 and the highest sensitivity (75%, p-value = 0.001). The highest specificity was achieved by the prothrombin time (69%), and the HALP score was also 69%. The FAR score had an AUC of 0.646, with a sensitivity of 68%, and specificity of 64% (p-value = 0.020). All other variables were significant estimates for the risk of preterm birth, although with lower accuracy. Pregnant women with a hemoglobin level below 12.0 g/dL had a 3.28 higher likelihood of giving birth prematurely. A prothrombin time below 12.5 s determined a 2.11 times higher risk of preterm birth. Similarly, the aPTT below 25 s was linked with 3.24 higher odds of giving birth prematurely. However, the strongest predictors were the D-dimers above 250 ng/mL (OR = 4.26), the FAR score below 0.1, with an odds ratio of 5.30, and the HALP score with a 6.09 OR for a cut-off value above 24. It is important to determine these parameters in pregnant women at risk for giving birth prematurely, but further external validation is required to confirm these findings. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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Review

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19 pages, 866 KiB  
Review
The Current Role of the sFlt-1/PlGF Ratio and the Uterine–Umbilical–Cerebral Doppler Ultrasound in Predicting and Monitoring Hypertensive Disorders of Pregnancy: An Update with a Review of the Literature
by Cristian Nicolae Chirilă, Claudiu Mărginean, Paula Maria Chirilă and Mirela Liana Gliga
Children 2023, 10(9), 1430; https://doi.org/10.3390/children10091430 - 22 Aug 2023
Viewed by 1552
Abstract
Regarding the hypertensive disorders of pregnancy, pre-eclampsia (PE) remains one of the leading causes of severe and life-threatening maternal and fetal complications. Screening of early-onset PE (<34 weeks of pregnancy), as well as late-onset PE (≥34 weeks), shows poor performance if based solely [...] Read more.
Regarding the hypertensive disorders of pregnancy, pre-eclampsia (PE) remains one of the leading causes of severe and life-threatening maternal and fetal complications. Screening of early-onset PE (<34 weeks of pregnancy), as well as late-onset PE (≥34 weeks), shows poor performance if based solely on clinical features. In recent years, biochemical markers from maternal blood—the pro-angiogenic protein placental growth factor (PlGF) and the antiangiogenic protein soluble FMS-like tyrosine kinase 1 (sFlt-1)—and Doppler velocimetry indices—primarily the mean uterine pulsatility index (PI), but also the uterine resistivity index (RI), the uterine systolic/diastolic ratio (S/D), uterine and umbilical peak systolic velocity (PSV), end-diastolic velocity (EDV), and uterine notching—have all shown improved screening performance. In this review, we summarize the current status of knowledge regarding the role of biochemical markers and Doppler velocimetry indices in early prediction of the onset and severity of PE and other placenta-related disorders, as well as their role in monitoring established PE and facilitating improved obstetrical surveillance of patients categorized as high-risk in order to prevent adverse outcomes. A sFlt-1/PlGF ratio ≤ 33 ruled out early-onset PE with 95% sensitivity and 94% specificity, whereas a sFlt-1/PlGF ≥88 predicted early-onset PE with 88.0% sensitivity and 99.5% specificity. Concerning the condition’s late-onset form, sFlt-1/PlGF ≤ 33 displayed 89.6% sensitivity and 73.1% specificity in ruling out the condition, whereas sFlt-1/PlGF ≥ 110 predicted the condition with 58.2% sensitivity and 95.5% specificity. The cut-off values of the sFlt-1/PlGF ratio for the screening of PE were established in the PROGNOSIS study: a sFlt-1/PlGF ratio equal to or lower than 38 ruled out the onset of PE within one week, regardless of the pregnancy’s gestational age. The negative predictive value in this study was 99.3%. In addition, sFlt-1/PlGF > 38 showed 66.2% sensitivity and 83.1% specificity in predicting the occurrence of PE within 4 weeks. Furthermore, 2018 ISUOG Practice Guidelines stated that a second-trimester mean uterine artery PI ≥ 1.44 increases the risk of later PE development. The implementation of a standard screening procedure based on the sFlt-1/PlGF ratio and uterine Doppler velocimetry may improve early detection of pre-eclampsia and other placenta-related disorders. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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21 pages, 595 KiB  
Review
Genetic Polymorphisms of Vascular Endothelial Growth Factor in Neonatal Pathologies: A Systematic Search and Narrative Synthesis of the Literature
by Monica G. Hăşmăşanu, Lucia M. Procopciuc, Melinda Matyas, Gabriela I. Zonda and Gabriela C. Zaharie
Children 2023, 10(4), 744; https://doi.org/10.3390/children10040744 - 19 Apr 2023
Viewed by 1227
Abstract
(1) Background: Vascular endothelial growth factor (VEGF) is essential in vasculo- and angiogenesis due to its role in endothelial cell proliferation and migration. As a vascular proliferative factor, VEGF is one of the hallmarks of cancer and, in adult populations, the relationship between [...] Read more.
(1) Background: Vascular endothelial growth factor (VEGF) is essential in vasculo- and angiogenesis due to its role in endothelial cell proliferation and migration. As a vascular proliferative factor, VEGF is one of the hallmarks of cancer and, in adult populations, the relationship between genetic polymorphism and neoplasm was widely investigated. For the neonatal population, only a few studies attempted to uncover the link between the genetic polymorphism of VEGF and neonatal pathology, especially related to late-onset complications. Our objective is to evaluate the literature surrounding VEGF genetic polymorphisms and the morbidity of the neonatal period. (2) Methods: A systematic search was initially conducted in December 2022. The PubMed platform was used to explore MEDLINE (1946 to 2022) and PubMed Central (2000 to 2022) by applying the search string ((VEGF polymorphism*) and newborn*). (3) Results: The PubMed search yielded 62 documents. A narrative synthesis of the findings was undertaken considering our predetermined subheadings (infants with low birth weight or preterm birth, heart pathologies, lung diseases, eye conditions, cerebral pathologies, and digestive pathologies). (4) Conclusion: The VEGF polymorphisms seem to be associated with neonatal pathology. The involvement of VEGF and VEGF polymorphism has been demonstrated for retinopathy of prematurity. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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Other

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10 pages, 1567 KiB  
Case Report
SARS-CoV-2 Infection during Pregnancy Followed by Thalamic Neonatal Stroke—Case Report
by Diana Iulia Vasilescu, Ana Maria Rosoga, Sorin Vasilescu, Ion Dragomir, Vlad Dima, Adriana Mihaela Dan and Monica Mihaela Cirstoiu
Children 2023, 10(6), 958; https://doi.org/10.3390/children10060958 - 27 May 2023
Cited by 1 | Viewed by 1429
Abstract
A neonatal stroke is a cerebrovascular process caused by interruption of cerebral blood flow that occurs with an incidence between 1 per 1600 and 1 per 2660 live births. Relative higher incidence in the neonatal period compared to later childhood is favored by [...] Read more.
A neonatal stroke is a cerebrovascular process caused by interruption of cerebral blood flow that occurs with an incidence between 1 per 1600 and 1 per 2660 live births. Relative higher incidence in the neonatal period compared to later childhood is favored by the hypercoagulability state of the mother, mechanical stress during delivery, transient right to left intracardiac shunt, high hematocrit, blood viscosity, and risk of dehydration during the first few days of life. The exact cause of a neonatal stroke remains unclear in many cases. About 80% of neonatal strokes are due to arterial ischemic events involving the middle cerebral artery. Typical clinical manifestations in a neonatal stroke are usually seizures that appear immediately after birth or after several days of life, but many of the cases may remain asymptomatic. We present the case of a late preterm infant diagnosed with a thalamic stroke on the fifth day of life with no clinical signs except for repeated episodes of apnea. The anamnesis and clinical context, in this case, revealed a SARS-CoV-2 infection in late pregnancy and early bacterial neonatal sepsis. Early identification of a perinatal stroke and increasing awareness of physicians about this condition in the neonatal period have paramount importance to reduce developmental postischemic damage. Full article
(This article belongs to the Special Issue Recent Advances in Obstetrics and Perinatal Medicine)
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