Experience and Prognosis of Systemic Neonatal Thrombosis at a Level III NICU

Ünal, Sevim; Gönülal, Deniz; Bilgin, Betül Siyah; Çulha, Vildan; Yaralı, Neşe

doi:10.1097/mph.0000000000001218

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…Throughout the entire childhood, the neonatal period is the period when thromboembolic events occur most commonly [12,16,35]. Vitamin K-dependent procoagulant factor levels and coagulation factor inhibitors, antithrombin III, protein C and S, are lower compared with other age groups.…”

Section: Discussionmentioning

confidence: 99%

Assessment of clinical characteristics and treatment outcomes of pediatric patients with intracardiac thrombosis: a single-center experience

Al¹,

Oymak²,

Erdem³

et al. 2021

Blood Coagulation &Amp; Fibrinolysis

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The prevalence of intracardiac thrombus (ICT) is gradually increasing, though it is rare among children. Data related to the occurrence of ICT among children are limited, and treatment recommendations have been made utilizing adult guidelines. The primary objective of this study is to determine associated factors, management, and outcomes of intracardiac thrombosis in children. Between January 2013 and January 2020, patients diagnosed with ICT at the Pediatric Hematology-Oncology and Pediatric Cardiology departments in our hospital were included in the study. Demographic characteristics, clinical and laboratory findings, treatment protocols, and outcomes were analyzed retrospectively. The median age at diagnosis was 10.5 months (2 days to 14.5 years), and the median follow-up period was 6.5 months (1 month to 3.1 years). The most common primary diagnoses of the patients, in order of frequency, were heart disease (n: 8), metabolic disease (n: 3), prematurity and RDS (n: 3), burns (n: 2), pneumonia (n: 2), and asphyxia (n: 2). CVC was present in 19/23 of the patients. The reasons for CVC insertion were the need for plasmapheresis in one patient with a diagnosis of HUS and the need for well tolerated vascular access because of long-term hospitalization in others. LMWH was administered to all patients as first-line therapy. Complete response was achieved in 19 (79%) of 24 patients and 4 patients (16.6%) were unresponsive to medical treatment. It was found out that the thrombus location, type, sepsis, and hemoculture positivity, as well as the presence of CVC, had no impact on treatment response (chi-square P = 0.16, 0.12, 0.3, 0.49, 0.56). Moreover, no correlation was determined between thrombus size and treatment response (Mann Whitney U test P = 0.47). The mortality rate was determined to be 12.5% (3/24). Spontaneous occurrence of ICT is rare in childhood, without any underlying primary disease or associated factor. The presence of CVC, sepsis, and heart disease are factors associated with ICT. The success rate is increased with medical treatment. There was no significant difference in treatment response between the newborn and 1 month to 18-year-old patient group. It has been demonstrated that thrombus size, type, localization; sepsis, and hemoculture positivity had no impact on the treatment response.

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Section: Discussionmentioning

confidence: 99%

Assessment of clinical characteristics and treatment outcomes of pediatric patients with intracardiac thrombosis: a single-center experience

Al¹,

Oymak²,

Erdem³

et al. 2021

Blood Coagulation &Amp; Fibrinolysis

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“…Although CVST is a rare condition, it appears that neonates are the most commonly affected pediatric age group, with an estimated combined incidence of approximately 1:1600–1:2300 live births [ 2 , 3 , 4 ]. The reported incidence of neonatal thrombosis over the last few years varied between 6.9–15 per 1000 neonates admitted to the intensive care unit (NICU) [ 5 , 6 , 7 , 8 ], and it appears to be higher than the previously reported incidence in the literature published in the 1990s and early 2000s (2.4–5.5 per 1000 admissions to the NICU) [ 9 , 10 ]. For cerebral sinovenous thrombosis, the Dutch registry reported an incidence ranging from 1–12 per 100.000 newborns, whereas the Canadian registry reports a higher rate of 47 per 100.000 newborns [ 2 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Neonatal Cerebral Sinovenous Thrombosis and the Main Perinatal Risk Factors—A Retrospective Unicentric Study

et al. 2022

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(1) Background: Neonatal cerebral sinovenous thrombosis (CSVT) is a rare disorder, associated with long-term neurological sequelae. The aim of this study was to retrospectively evaluate the most commonly encountered perinatal risk factors for this disease in a cohort of newborns from Romania. (2) Methods: The medical records of neonatal CSVT patients treated between January 2017 and December 2021 were descriptively assessed. (3) Results: The study included nine neonates, five males (55.56%) and four females (44.44%), who were born at term. The most commonly presented clinical manifestations were feeding difficulties, lethargy, respiratory distress, loss of consciousness, and seizures. Maternal-inherited thrombophilia, male sex, complicated delivery, perinatal asphyxia, and mechanical ventilation were frequently identified as potential risk factors for developing CSVT. The lesions were more frequently localized in the superior sagittal sinus (n = 7; 77.78%), followed by the transverse (n = 4; 44.44%), sigmoid (n = 2; 22.22%), and cavernous (n = 1; 11.11%) sinuses. Low-molecular-weight heparin was administered to all patients, and two of them died from thrombotic complications. (4) Conclusions: Recognition of potential risk factors and a prompt diagnosis of neonatal CSVT could lead to better patient management and to a reduction of severe complications.

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“…Given the relatively rare occurrence of neonatal VTE, the numbers of patients who had the outcome of interest was low, with thrombosis occurring in <100 patients in these studies. These were followed by retrospective case series and case-control studies, which continued to identify possible risk factors (CVC, infection, prematurity/small for gestational age, maternal diabetes, and dehydration/polycythemia) [ 4 , 16 – 18 ] but were also limited by small sample sizes, subpopulations (congenital heart disease), specific type of central lines (umbilical venous catheters, peripherally inserted central catheters (PICCs)), or risk factors (infection) [ 19 – 21 ]. Additionally, more recent data indicate the incidence of neonatal VTE is now higher than was reported in the 1990s and early 2000s [ 4 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of venous thromboembolism among infants in children’s hospitals in the United States: a retrospective Pediatric Health Information Study

Easterlin

Yieh

et al. 2021

J Perinatol

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Objectives Examine: (1) Prevalence of diagnosed venous thromboembolism (VTE) in infants <6 months discharged from U.S. NICUs; (2) Associations between sociodemographic and clinical factors and VTE; (3) Secondary outcomes related to VTE. Study design Multivariable logistic regressions examined associations between VTE and sociodemographic and clinical factors among infants <6 months discharged from Pediatric Health Information System (PHIS) NICUs between 2016 and 2019. Results Of 201,033 infants, 2720 (1.35%) had diagnosed VTE. Birthweight 300–1000 g (aOR 3.14, 95% CI 2.54–3.88), 1000–1500 g (aOR 1.77, 95% CI 1.40–2.42) versus 2500–3999 g, and public (aOR 1.18, 95% CI 1.02–1.37) versus private insurance were associated with increased odds of VTE, as were CVC, TPN, mechanical ventilation, infection, ECMO, and surgery. All types of central lines (non-tunneled and tunneled CVCs, PICCs, and umbilical catheters) had higher odds of VTE than not having that type of line. CVCs in upper versus lower extremities had higher odds of VTE. Conclusion Infants with risk factors may require monitoring for VTE. Results may inform VTE prevention.

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Experience and Prognosis of Systemic Neonatal Thrombosis at a Level III NICU

Abstract: Critically ill neonates are at risk for thrombosis, and devastating consequences can result. As indwelling catheters and prematurity are important, careful monitorization, early diagnosis and therapy, cautious care of central catheter might reduce the incidence and adverse outcome.

Cited by 10 publications

References 29 publications

Assessment of clinical characteristics and treatment outcomes of pediatric patients with intracardiac thrombosis: a single-center experience

Assessment of clinical characteristics and treatment outcomes of pediatric patients with intracardiac thrombosis: a single-center experience

Neonatal Cerebral Sinovenous Thrombosis and the Main Perinatal Risk Factors—A Retrospective Unicentric Study

Predictors of venous thromboembolism among infants in children’s hospitals in the United States: a retrospective Pediatric Health Information Study

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