Neonatal cerebral ischaemia with elevated maternal and infant anticardiolipin antibodies

A baby girl born by elective lower segment caesarean section was found to h ave left-sided focal seizures at 48 hours after birth. Her mother had previ ously had a neonatal death at 26 weeks' gestation and another child born at 32 weeks' gestation had a congenital right hemiplegia with a left middle c erebral artery infarct on CT scan. The mother had raised anticardiolipin Ig G antibodies at the time of delivery of her second child, with no thromboti c symptoms. Therefore, during this pregnancy, she had been treated with low molecular weight heparin and aspirin. The baby's mother had raised IgG and IgM anticardiolipin antibodies and the baby had IgG; anticardiolipin antib odies at the upper range of normal 4 days after delivery. The seizures were controlled with phenobarbitone and phenytoin. CT and MRI scans showed evid ence of cerebral ischaemia. A repeat MRI scan at 4 months of age was normal , anticonvulsants were discontinued, and her latest neurological examinatio n at 5 months was normal.