Neonatal Thrombosis: A Critical Appraisal of the Available Evidence on Prevention, Diagnosis, and Treatment

Abstract

Thrombotic disease in newborn infants is common and serious enough to require effective and safe prevention and treatment [1]. However, thrombotic disease in newborns is also sufficiently rare to prompt anecdotal observations rather than controlled clinical trials. While there is an abundance of case reports in the pediatric literature, there is a conspicuous paucity of well-designed studies [2]. As a result, consensus about the appropriate prophylaxis and management of neonatal thrombosis is lacking [2]. In this article, we will examine the available evidence on the efficacy and safety of heparin prophylaxis in infants with indwelling umbilical artery catheters. We will also review the management of symptomatic thrombosis, using aortic thrombosis as an example. We begin with a description of the framework which will be used to assess the strength of evidence that supports current approaches to neonatal thrombosis.