Pediatr. praxi. 2024;25(6):402-406 | DOI: 10.36290/ped.2024.076

Thrombotic events in newborns

MUDr. Ondřej Zapletal, Ph.D., MUDr. Pavel Mazánek

Oddělení dětské hematologie FN Brno, LF MU Brno

Introduction: Thrombotic events are a relatively rare disease in the neonatal period. They usually occur as a complication of another disease or its treatment, with infection, childbirth complications and the insertion of a catheter into a vessels being an important risk factor. Current recommendations for the treatment and prophylaxis of thrombosis in newborns are based on the 9th ACCP consensus and the recent recommendations of ASH and ISTH. Heparins (unfractionated heparin (UFH) and low molecular weight heparin (LMWH)) are the drug of choice for initial treatment. The treatment strategy for newborns differs in some aspects from the treatment of older children. It is mainly a higher dosage of LMWH and a different duration of treatment. Cohort and methods: This work maps thrombotic events in children from birth to 28 days of age, diagnosed and treated in neonatal units in cooperation with the Department of Pediatric Hematology and Biochemistry University Hospital Brno from 2011 to 2023.

Results: In the observed period, 19 children in newborn age were treated for a thrombotic event. There were 11 boys and 8 girls treated, weight from 780 up to 4 600 g, only four children were premature (born before the 37th week of pregnancy). A thrombotic event was diagnosed at 0-22 days of age. In our group, venous thrombotic events predominate (84%), with most frequent cerebral sinovenous thrombosis (42%). All but one patient were treated with low-molecular-weight heparins. In most of the cases, the treatment was initiated via continuous infusion, later converted to standard subcutaneous administration. One patient was treated with dabigatran in a clinical trial after initial LMWH treatment. The median duration of treatment was 66 days, with a range of 0-105 days. Full regression of thrombotic changes was achieved in 63% of patients, at least partial regression of thrombosis in 84%. We did not notice any treatment complications. The treatment was well tolerated by patients and parents.

Conclusion: Diagnosis of thrombotic events in the neonatal period requires experienced personnel, laboratory background and imaging methods. The treatment should be managed by a paediatric haematologist. Low molecular weight heparins are currently the drug of choice for initial treatment. A well guided therapy combined with the treatment of often underlying diseases has a high probability of thrombosis regression.

Keywords: thrombosis, newborns, low molecular weight heparin.

Accepted: December 10, 2024; Published: December 31, 2024  Show citation