{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T16:03:41Z","timestamp":1777046621497,"version":"3.51.4"},"reference-count":7,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:p>There are few published reports of neonates born with necrotic skin lesions and stroke. We report the case of a neonate with an identified placental etiology for necrotic skin lesions at birth and multiple arterial thrombi, including a stroke. This neonate was born to a generally healthy mother with gestational hypertension on labetalol in pregnancy. She was born via emergency Caesarean section at 38\u2009+\u20091 weeks\u2019 gestational age due to biophysical profile 2 of 8 and oligohydramnios and was noted to have multiple necrotic skin lesions on the left forearm. She was found to have numerous arterial thrombi, including a left-sided middle cerebral artery stroke. An extensive workup into the etiology of thrombi was done with no hematologic, metabolic, genetic, or infectious cause identified. Her placental pathology examination identified high-grade fetal vascular malperfusion, which encompasses various obstructive fetal vascular lesions, fetal thrombotic vasculopathy, and fetal vascular thrombi. Although fetal vascular malperfusion cannot be detected antenatally at the present time, postnatal identification can bring closure to families and help for subsequent pregnancy planning. Additionally, necrotic skin lesions in neonates present at delivery should prompt clinicians to do imaging to identify thrombi because initiating early postnatal treatment may be of critical clinical importance.<\/jats:p>","DOI":"10.1542\/peds.2024-069518","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T20:02:36Z","timestamp":1748980956000},"source":"Crossref","is-referenced-by-count":0,"title":["Neonate With Necrotic Skin Lesions and Middle Cerebral Artery Stroke in\u00a0the Context of Fetal Vascular Malperfusion"],"prefix":"10.1542","volume":"156","author":[{"given":"Marisa","family":"de Souza","sequence":"first","affiliation":[{"name":"1Neonatal Perinatal Medicine Residency Program, University of Ottawa, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina","family":"El Demellawy","sequence":"additional","affiliation":[{"name":"2Department of Pathology, University of Ottawa, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda","family":"Waugh","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Division of Dermatology and Rheumatology, Children\u2019s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Liy Wong","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Division of Dermatology and Rheumatology, Children\u2019s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian","family":"Maclean","sequence":"additional","affiliation":[{"name":"4Department of Pediatrics, Kingston Health Sciences Centre, Kingston, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JoAnn","family":"Harrold","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, Children\u2019s Hospital of Eastern Ontario, Ottawa, Canada"},{"name":"6Research Institute, Children\u2019s Hospital of Eastern Ontario, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah L.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, Children\u2019s Hospital of Eastern Ontario, Ottawa, Canada"},{"name":"6Research Institute, Children\u2019s Hospital of Eastern Ontario, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"issue":"7","key":"2026042410564175600_r1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1111\/apm.12849","article-title":"Fetal vascular malperfusion, an update","volume":"126","author":"Redline","year":"2018","journal-title":"APMIS."},{"issue":"2","key":"2026042410564175600_r2","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1055\/s-0034-1382257","article-title":"Neonatal Volkmann ischemic contracture: case report and review of literature","volume":"4","author":"Dokania","year":"2014","journal-title":"AJP Rep."},{"issue":"1","key":"2026042410564175600_r3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1177\/1093526620962061","article-title":"Fetal vascular malperfusion due to long and hypercoiled umbilical cords resulting in recurrent second trimester pregnancy loss: a case series and literature review","volume":"24","author":"Slack","year":"2021","journal-title":"Pediatr Dev Pathol."},{"key":"2026042410564175600_r4","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.placenta.2022.07.016","article-title":"Umbilical cord compromise versus other clinical conditions predisposing to placental fetal vascular malperfusion","volume":"127","author":"Stanek","year":"2022","journal-title":"Placenta."},{"issue":"3","key":"2026042410564175600_r5","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1177\/0883073807300539","article-title":"Necrotic skin lesions and cerebral infarction in the newborn: two case reports","volume":"22","author":"Bednarek","year":"2007","journal-title":"J Child Neurol."},{"issue":"11","key":"2026042410564175600_r6","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.5858\/arpa.2017-0212-RA","article-title":"Fetal vascular malperfusion","volume":"141","author":"Heider A","year":"2017","journal-title":"Arch Pathol Lab Med."},{"issue":"6","key":"2026042410564175600_r7","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1038\/s41379-021-00747-4","article-title":"Four major patterns of placental injury: a stepwise guide for understanding and implementing the 2016 Amsterdam consensus","volume":"34","author":"Redline","year":"2021","journal-title":"Mod Pathol."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2024-069518\/1818245\/pediatrics.2024069518.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2024-069518\/1818245\/pediatrics.2024069518.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:56:47Z","timestamp":1777042607000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/156\/1\/e2024069518\/202045\/Neonate-With-Necrotic-Skin-Lesions-and-Middle"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,6,4]]},"published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2024-069518","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]},"article-number":"e2024069518"}}