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Awareness of Risk Factors Needed to Suspect Neonatal Thromboembolism
A DGReview of :"Neonatal thromboembolism"
Seminars in Thrombosis and Hemostasis
05/15/2003
By Deanna M. Green
Greater awareness of risk factors and more clinical data regarding treatment is needed to improve management of thromboembolism in neonates and infants, according researchers from, Germany and France.
Venous and arterial thromboses are rare diseases that are recently being recognized more often in infancy and childhood. Among all children, neonates have the highest risk of thromboembolic complications, with an incidence of about 5.1 of every 100,000 live births in Germany.
In order to increase recognition and diagnosis of thromboembolism in neonates and infants, physicians should be aware of acquired risk factors that cause increases in thrombin production, say to Dr. Ulrike Nowak-Gottl and colleagues.
Risk factors include perinatal diseases, such as asphyxia and maternal diabetes; medical interventions, such as umbilical arterial and venous catheters and central lines; acute diseases, including cardiac and renal diseases; and chronic diseases, such as metabolic disorders and cardiac abnormalities.
Other risk factors include genetic and biochemical aberrations in prothrombotic factors compared to age-dependent normal reference values. Protein and DNA-based laboratory tests that can detect these differences are highly recommended for symptomatic neonates and young infants.
Unresolved renal venous thromboses and vena cava occlusion can lead to long-term morbidity with a high frequency of irreversible organ damage, including residual structural abnormalities, impairment of renal function, and hypertension.
To avoid such outcomes, current treatments for neonatal thrombosis include low molecular weight heparin, which can also cause heparin-induced thrombocytopenia (HIT) type II in some children; thrombolytic therapy, most commonly in the form of urokinase and recombinant tissue type plasminogen activator (rt-PA); and secondary anticoagulation, a treatment option that should be prescribed on a patient-by-patient basis.
One caveat is that treatments for neonatal thromboembolism have been chosen based on data from small-scale studies in children and on guidelines adapted from adult patient protocols. The investigators noted that "detailed patient management is significantly hampered by the lack of appropriate clinical trials."
Semin Thromb Hemost 2003 Apr;29:2:227-34.
"Neonatal thromboembolism"
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