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2017 ; 5
(ä): 136
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Neonatal Venous Thromboembolism
#MMPMID28634578
Haley KM
Front Pediatr
2017[]; 5
(ä): 136
PMID28634578
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Neonates are the pediatric population at highest risk for development of venous
thromboembolism (VTE), and the incidence of VTE in the neonatal population is
increasing. This is especially true in the critically ill population. Several
large studies indicate that the incidence of neonatal VTE is up almost threefold
in the last two decades. Central lines, fluid fluctuations, sepsis, liver
dysfunction, and inflammation contribute to the risk profile for VTE development
in ill neonates. In addition, the neonatal hemostatic system is different from
that of older children and adults. Platelet function, pro- and anticoagulant
proteins concentrations, and fibrinolytic pathway protein concentrations are
developmentally regulated and generate a hemostatic homeostasis that is unique to
the neonatal time period. The clinical picture of a critically ill neonate
combined with the physiologically distinct neonatal hemostatic system easily
fulfills the criteria for Virchow's triad with venous stasis, hypercoagulability,
and endothelial injury and puts the neonatal patient at risk for VTE development.
The presentation of a VTE in a neonate is similar to that of older children or
adults and is dependent upon location of the VTE. Ultrasound is the most common
diagnostic tool employed in identifying neonatal VTE, but relatively small
vessels of the neonate as well as frequent low pulse pressure can make ultrasound
less reliable. The diagnosis of a thrombophilic disorder in the neonatal
population is unlikely to change management or outcome, and the role of
thrombophilia testing in this population requires further study. Treatment of
neonatal VTE is aimed at reducing VTE-associated morbidity and mortality.
Recommendations for treating, though, cannot be extrapolated from guidelines for
older children or adults. Neonates are at risk for bleeding complications,
particularly younger neonates with more fragile intracranial vessels.
Developmental alterations in the coagulation proteins as well as unique
pharmacokinetics must also be taken into consideration when recommending VTE
treatment. In this review, epidemiology of neonatal VTE, pathophysiology of
neonatal VTE with particular attention to the developmental hemostatic system,
diagnostic evaluations of neonatal VTE, and treatment guidelines for neonatal VTE
will be reviewed.
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