Thrombophilia in neonates
Newborn infants are the most susceptible to developing thrombosis or serious thromboembolic complications. More specifically, critically ill neonates are at the greatest risk of developing thromboembolic disease.1
The neonatal haemostatic system is both quantitatively and qualitatively distinct from that of an older child or adult. The neonate exists in an evolving balance of pro-and anticoagulant factors. However the balance is delicate and can be easily tipped.2
There are a variety of acquired risk factors that change the balance of the haemostatic system towards thrombosis. One of the main risk factors is the presence of central venous catheter (CVC) infections. In addition to this, other factors such as sepsis, mechanical ventilation, perinatal asphyxia and congenital heart disease can also play a role.2
Congenital thrombophilia has been shown to have a higher probability of being present in neonates who have primarily renal, portal or hepatic venous thrombosis. These infants develop the life-threatening complications of purpura fulminans.1
Critical signs and symptoms of thromboembolism in critically ill neonates
EXTREMITIES |
INTESTINE
|
KIDNEY
|
AORTA
|
CNS
|
LUNG
|
|
|---|---|---|---|---|---|---|
| ARTERIAL |
Pale and/or cold Pulse weak or absent Reduced blood pressure |
Feeding intolerance Bilious gastric aspirates Bloody stools Bowel wall pneumostasis |
Elevated blood pressure |
Blood pressure higher in arms than in legs |
Lethargy seizures (No hemiplegia) |
Right heart failure Low oxygen saturation Ventilation/ perfusion mismatch |
| VENOUS |
Swelling Pain Cyanosis Hyperemia |
Feeding intolerance Bilious gastric aspirates Bloody stools Bowel wall pneumostasis |
Hematuria Proteinuria Abdominal mass |
Inferior vena cava Hematuria Lower limb edema Both kidneys palpable Respiratory distress |
Lethargy seizures |
References:
-
Veldman A, et al. Thrombosis in the critically ill neonate: incidence, diagnosis, and management. Vasc Health Risk Manag. 2008;4:1337-48.
-
Haley KM. Neonatal Venous Thromboembolism. Front Pediatr. 2017;5:136.
