Thromboembolic Diseases in Neonates and Children

Nowak‐Göttl, Ulrike; Duering, Christine; Kempf-Bielack, Beate; Sträter, Ronald

doi:10.1159/000083813

Cited by 55 publications

(50 citation statements)

References 80 publications

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“…There are little data available with respect to the presence of inherited prothrombotic risk factors in specific pediatric populations other than Jews and Caucasians. 6 The neonatal hemostatic system The neonatal procoagulant, anticoagulant and fibrinolytic systems are unique and differ from those of children and adults. 7 Although many of these unique qualities place a neonate in a 'relative' prothrombotic state, they tend to be balanced by other factors that prevent a term or 'relatively well' premature infant from experiencing spontaneous thromboses ( Figure 1).…”

Section: Incidence Of Neonatal Thromboembolic Diseasementioning

confidence: 99%

“…Spontaneous arterial thromboses, though extremely rare, are usually severe and mostly involve the aorta tending to mimic congenital heart disease. 3,4,6,61,62 Optimal imaging strategy is vital to make the correct diagnosis and to initiate the proper treatment to minimize end-organ complications. Decreased pulses or the presentation of a cool-mottled extremity should alert the clinician to a possible arterial thrombosis, especially if echocardiography does not determine evidence for aortic coarctation or other heart lesion that restricts left ventricular outflow.…”

Section: Arterial Thrombosesmentioning

confidence: 99%

“…The protein-based assays (Tables 3 and 4) are affected by the thrombotic event and must be repeated at 3 to 6 months of life before a definitive diagnosis can be made. 6,88 At our institution, we perform laboratory evaluation 1 (Table 3) if other significant risk factors are present (Table 2). This evaluation is focused on the more common prothrombotic risk factors.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…DNA-based assays are neither influenced by the acute thrombotic event nor the treatment and are reliable if obtained during the acute event. 6 Lipoprotein-a concentrations tend to increase during the first year of life and are recommended to be repeated at 8 to 12 months of life following the acute event if the original values are low, especially in Caucasian individuals. 6,33,100 A concern to performing this evaluation is the large amount of blood believed to be required.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…6 Lipoprotein-a concentrations tend to increase during the first year of life and are recommended to be repeated at 8 to 12 months of life following the acute event if the original values are low, especially in Caucasian individuals. 6,33,100 A concern to performing this evaluation is the large amount of blood believed to be required. This is especially important in the premature or anemic infant where excessive blood loss is not a tolerable option.…”

Section: Venous Thrombosismentioning

confidence: 99%

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The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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In the pediatric population, neonates have the highest risk for thromboembolism (TE), most likely due to the frequent use of intravascular catheters. This increased risk is attributed to multiple risk factors. Randomized clinical trials dealing with management of postnatal thromboses do not exist, thus, opinions differ regarding optimal diagnostic and therapeutic interventions. This review begins with an actual case study illustrating the complexity and severity of these types of cases, and then evaluates the neonatal hemostatic system with discussion of the common sites of postnatal thrombosis, perinatal and prothrombotic risk factors, and potential treatment options. A proposed step-wise evaluation of neonates with symptomatic postnatal thromboses will be suggested, as well as future research and registry directions. Owing to the complexity of ischemic perinatal stroke, this topic will not be reviewed. Case study A full-term male infant born through spontaneous vaginal delivery was admitted to the neonatal intensive care unit (NICU) shortly after birth due to a history of low APGAR scores and respiratory distress requiring mechanical ventilation. The pregnancy was complicated by gestational diabetes treated with glyburide and chorioamnionitis was evident during labor. The patient was started on ampicillin and gentamicin and appropriate fluid resuscitation was initiated. The patient improved over the next few days and was able to be weaned off of ventilator support. The patient had an umbilical arterial catheter (UAC) placed after birth that was removed on day 3 of life.On day 4 of life the patient's legs appeared pale. Physical examination demonstrated cool lower extremities and markedly decreased pulses in the feet. Over the previous 24 h, urine output declined significantly.Ultrasound (US) examination of the heart, major vessels and abdomen demonstrated a large thrombus in the descending aorta with very minimal flow to the renal and iliac arteries. A literature search did not reveal any level I management guidelines for thrombosis in neonatal patients, and consideration is now given to surgical thrombectomy, anticoagulation therapy or fibrinolytic therapy. Incidence of neonatal thromboembolic diseaseAlthough neonates have the highest risk of thromboembolism (TE) in the pediatric population, the incidence of postnatal TE varies due to the types of thromboses that were reported and how aggressively centers screened for thromboses. 1 Data from the three international registries are displayed in Table 1. All three registries observed that thromboses occurred in both term and preterm infants and affected male and female infants equally, other than renal vein thrombosis (RVT) that affected more male neonates. [2][3][4] These registries also demonstrated that approximately 90% of venous thromboses in neonates were associated with central venous catheters (CVLs). [2][3][4] The recurrence rate of TE following symptomatic neonatal events ranges from 3.3 to 7%. 5 The international registries are the first step toward...

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Section: Incidence Of Neonatal Thromboembolic Diseasementioning

confidence: 99%

Section: Arterial Thrombosesmentioning

confidence: 99%

Section: Venous Thrombosismentioning

confidence: 99%

Section: Venous Thrombosismentioning

confidence: 99%

Section: Venous Thrombosismentioning

confidence: 99%

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The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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Risk factors for umbilical venous catheter‐associated thrombosis in very low birth weight infants

Narang

Roy

Stevens

et al. 2008

Pediatric Blood & Cancer

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BackgroundThrombosis in neonates is a rare but serious occurrence, usually associated with central catheterization. The objective of this study was to investigate the risk factors associated with catheter related thrombosis in very low birth weight (VLBW) infants.ProcedureThe present retrospective study was performed using data from a randomized trial of duration of umbilical venous catheters (UVC) placement among infants <1,250 g birth weight. Twenty‐two cases of UVC‐associated thrombosis were identified in this sample. The remaining study sample (n = 188) served as the comparison group. Data on thrombosis, platelets, gestational age, birth weight, hematocrit, serum sodium, maternal preeclampsia, blood group, infant of diabetic mother (IDM) and demographic factors were collected using database and record review.ResultsAmong the total subjects (n = 210), 112 (53%) were males and 126 (60%) were Caucasians, with mean gestational age of 27.7 ± 2.1 weeks (standard deviation) and mean birth weight of 923 ± 195 g. Bivariate analysis revealed significant association of thrombosis with hematocrit >55% in the first week (odds ratio [OR] 5.4; 95% confidence interval [CI] 2.0–14.6; P = 0.0003), being small for gestational age (SGA) (OR, 2.9; 95% CI, 1.2–7.4; P = 0.02) and maternal preeclampsia (OR, 3.97; 95% CI, 1.6–9.84; P = 0.0017). In multivariate logistic regression analysis, only hematocrit >55% was independently associated with thrombus (OR, 3.7; 95% CI 1.1–11.8; P = 0.03).ConclusionsThis study demonstrates a significant, independent association between elevated hematocrit and development of UVC‐associated thrombosis. Careful monitoring for catheter‐associated thrombosis may be indicated in VLBW infants who have hematocrit >55% in the first week of life. Pediatr Blood Cancer 2009;52:75–79. © 2008 Wiley‐Liss, Inc.

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Perioperatives Management von Gerinnungsstörungen

Kurnik¹,

Bidlingmaier²

2009

Kinderchirurgie

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Thromboembolic Diseases in Neonates and Children

Cited by 55 publications

References 80 publications

The evaluation and management of postnatal thromboses

The evaluation and management of postnatal thromboses

Risk factors for umbilical venous catheter‐associated thrombosis in very low birth weight infants

Perioperatives Management von Gerinnungsstörungen

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