Enoxaparin Use in the Neonatal Intensive Care Unit: Experience Over 8 Years

Malowany, Janet I.; Knoppert, David; Chan, Anthony; Pepelassis, Dion; Lee, David S. C.

doi:10.1592/phco.27.9.1263

Cited by 88 publications

(81 citation statements)

References 35 publications

(67 reference statements)

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“…Subcutaneous enoxaparin seems to be the most frequently used substance in term and preterm neonates. Data published on the use of enoxaparin in 12 preterm and 4 term infants found no serious adverse events and a resolution of TE in 71% of the patients (Malowany et al 2007).…”

Section: Medicalmentioning

confidence: 85%

Thrombosis in the critically ill neonate: incidence, diagnosis, and management

Nold¹

2008

VHRM

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Among children, newborn infants are most vulnerable to development of thrombosis and serious thromboembolic complications. Amongst newborns, those neonates who are critically ill, both term and preterm, are at greatest risk for developing symptomatic thromboembolic disease. The most important risk factors are infl ammation, DIC, impaired liver function, fl uctuations in cardiac output, and congenital heart disease, as well as exogenous risk factors such as central venous or arterial catheters. In most clinically symptomatic infants, diagnosis is made by ultrasound, venography, or CT or MRI angiograms. However, clinically asymptomatic vessel thrombosis is sometimes picked up by screening investigations or during routine imaging for other indications. Acute management of thrombosis and thromboembolism comprises a variety of approaches, including simple observation, treatment with unfractionated or low molecular weight heparin, as well as more aggressive interventions such as thrombolytic therapy or catheter-directed revascularization. Long-term follow-up is dependent on the underlying diagnosis. In the majority of infants, stabilization of the patients' general condition and hemodynamics, which allows removal of indwelling catheters, renders long-term anticoagulation superfl uous. Nevertheless, in certain types of congenital heart disease or inherited thrombophilia, long-term prophylaxis may be warranted. This review article focuses on pathophysiology, diagnosis, and acute and long-term management of thrombosis in critically ill term and preterm neonates.

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Section: Medicalmentioning

confidence: 85%

Thrombosis in the critically ill neonate: incidence, diagnosis, and management

Nold¹

2008

VHRM

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“…111,124,125 However, clinical trials have not been performed to confi rm the safety and efficacy of this approach, and it is diffi cult to recommend the optimal initial dosing strategy for term and premature neonates at this time.…”

Section: Dosesmentioning

confidence: 99%

Antithrombotic Therapy in Neonates and Children

Monagle

Chan

Goldenberg

et al. 2012

Chest

1,241

559

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“…Only one patient, a 24-week infant, required antibiotic treatment secondary to an infected hematoma. 125 LMWH therapy has been effective in the NICU, and centers have reported either partial or complete resolution of TE events between 59 and 100%. 125,126 The traditional initial treatment dose of enoxaparin is displayed in Table 6.…”

Section: Management Of Thrombosismentioning

confidence: 99%

“…125 LMWH therapy has been effective in the NICU, and centers have reported either partial or complete resolution of TE events between 59 and 100%. 125,126 The traditional initial treatment dose of enoxaparin is displayed in Table 6. A recent review evaluating enoxaparin use in 240 neonates found that the mean maintenance dose of enoxaparin ranged from 1.48 to 2.27 mg kg À1 per 12 h for all infants, but was higher for preterm neonates at 1.9 to 2.27 mg kg À1 per 12 h. 125 Therefore, newer recommendations are displayed in Table 6.…”

Section: Management Of Thrombosismentioning

confidence: 99%

“…125,126 The traditional initial treatment dose of enoxaparin is displayed in Table 6. A recent review evaluating enoxaparin use in 240 neonates found that the mean maintenance dose of enoxaparin ranged from 1.48 to 2.27 mg kg À1 per 12 h for all infants, but was higher for preterm neonates at 1.9 to 2.27 mg kg À1 per 12 h. 125 Therefore, newer recommendations are displayed in Table 6. The goal of treatment is to maintain an anti-FXa concentration of 0.5 to 1.0 U ml À1 .…”

Section: Management Of 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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Enoxaparin Use in the Neonatal Intensive Care Unit: Experience Over 8 Years

Cited by 88 publications

References 35 publications

Thrombosis in the critically ill neonate: incidence, diagnosis, and management

Thrombosis in the critically ill neonate: incidence, diagnosis, and management

Antithrombotic Therapy in Neonates and Children

The evaluation and management of postnatal thromboses

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