By Eleanor McDermid, medwireNews Reporter
medwireNews: Children with foetal neonatal alloimmune thrombocytopenia (FNAIT) are at high risk of impaired neurodevelopment, especially if they have experienced intracranial haemorrhage (ICH), shows research in The Journal of Pediatrics.
“These findings stress the importance of preventing severe bleeding in FNAIT and therefore the development of assays that can identify pregnancies at risk for bleeding within [human platelet antigen] alloimmunized pregnant women”, say Thijs de Vos (Leiden University Medical Center, the Netherlands) and co-researchers.
“By identification of these pregnancies, antenatal treatment could prevent the occurrence of ICH and cerebral injury and thereby the associated adverse outcome.”
The 44 children in the study were assessed for neurodevelopmental outcomes at a median age of 12 years, ranging from 6 years to 17 years. At this stage, neurodevelopmental impairment (NDI) was identified in 32% of the cohort, with three (7%) children having severe NDI and 11 (25%) mild-to-moderate NDI.
Of note, all three children with severe NDI had ICH identified on perinatal cerebral imaging – one low-grade and one high-grade parenchymal haemorrhage and one high-grade intraventricular haemorrhage. Two of these children had cerebral palsy. A second child with high-grade intraventricular haemorrhage had mild-to-moderate NDI; they had a low IQ of 70 and complex minor neurological dysfunction.
In total, eight of 41 children tested had minor neurological dysfunction – simple in four and complex in four. The average IQ score of 43 assessed children was 98, which did not significantly differ from the Dutch population norm, but 16% had mild-to-moderate cognitive impairment and 5% had severe impairment.
ICH was identified in a total of eight children among 36 who underwent perinatal cerebral imaging, and four of these – two of whom had high-grade ICH – did not have NDI at follow-up.
“[T]his finding fits in with previous literature in which children can have normal neurodevelopment despite severe brain hemorrhage”, say the researchers.
However, the team suspected that children with FNAIT could have impaired neurodevelopmental outcomes even in the absence of ICH.
“This expectation was based on increasing evidence that the maternal alloantibodies in FNAIT not only cause platelet destruction but possibly interfere with endothelial cells”, they write.
“This might result in small cerebral bleeding and/or impaired (cerebral) angiogenesis that remains clinically undetectable directly after birth, but in the long term affects brain development leading to developmental delay.”
Indeed, just one of the 11 children with mild-to-moderate NDI had ICH, and the majority had no abnormalities on cranial ultrasound. Half of these children had minor neurological dysfunction, which the researchers say could be due “to subclinical cerebral damage that remained undiagnosed” in infancy but nonetheless affected the children’s neurodevelopment.
The team concludes that “children newly diagnosed with FNAIT who survive the neonatal period are at high increased risk of long-term neurodevelopmental problems and therefore should have postnatal neuroimaging and be monitored adequately in a standardized follow-up program.”
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J Pediatr 2023; doi:10.1016/j.jpeds.2023.02.031