"APS pregnancy - The offspring"

Symptomatic aortic thrombosis in a preterm neonate

Symptomatic aortic thrombosis is a devastating condition in the neonatal intensive care unit (NICU), which is now increasingly being diagnosed with the availability of bedside ultrasound. Early intervention can go a long way towards preventing adverse outcomes. In our case, a preterm, very low birth weight, growth-restricted baby developed aortic thrombosis with hypertensive emergency and later limb-threatening ischaemia, which usually requires thrombolysis. However, due to the parents' reservations, he was given only therapeutic anticoagulation (with closely monitored activated partial thromboplastin time targets), which resulted in complete thrombus resolution. A multidisciplinary team approach was followed, and early detection with frequent monitoring led us to a favourable outcome.

Pediatric Antiphospholipid Syndrome: from Pathogenesis to Clinical Management

PURPOSE OF REVIEW

Elucidating the pathogenic mechanisms mediated by antiphospholipid antibodies (aPL) might exert important clinical implications in pediatric antiphospholipid syndrome (APS).

RECENT FINDINGS

aPL are traditionally regarded as the main pathogenic players in APS, inducing thrombosis via the interaction with fluid-phase and cellular components of coagulation. Recent APS research has focused on the role of β2 glycoprotein I, which bridges innate immunity and coagulation. In pediatric populations, aPL should be screened in appropriate clinical settings, such as thrombosis, multiple-organ dysfunction, or concomitant systemic autoimmune diseases. Children positive for aPL tests often present non-thrombotic non-criteria manifestations or asymptomatic aPL positivity. In utero aPL exposure has been suggested to result in developmental disabilities, warranting long-term follow-up. The knowledge of the multifaceted nature of pediatric APS should be implemented to reduce the risk of underdiagnosing/undertreating this condition. Hopefully, recent pathogenic insights will open new windows of opportunity in the management of pediatric APS.