The management of neonatal venous thrombosis – an interdisciplinary team effort

Abstract

Managing venous thrombosis in neonates poses numerous difficulties. Thrombotic events, whether arterial or venous, in newborns, can lead to significant morbidity and mortality within the hospitalized infant population. Neonates represent the age group with the highest susceptibility to developing thrombosis among pediatric patients. The evolving coagulation system, the necessity for intensive care, which often involves invasive procedures, and the presence of coexisting medical conditions collectively render neonates more prone to developing thrombosis compared to older children. Neonatal thrombosis is intertwined with the well-being of the mother and the newborn. We report a case of a very preterm newborn (30 weeks of gestation), extremely low birth weight (900g), with a multitude of prematurity related complications, who developed venous thrombosis at 5 weeks of life. She underwent prolonged hospitalization in the NICU, required mechanical ventilation, received nutritional and metabolic support via a central venous catheter, and complex treatments for sepsis with Staphylococcus CoNS. Genetic and hematology consults raised questions about the genetic basis of the thrombosis pathology, specifically thrombophilia or a RASopathy (Phenotype Noonan-like Syndrome). The prompt identification of risk factors leads to early therapeutic intervention, and multidisciplinary assessments are necessary to manage it. Conclusions. Neonatal thrombosis is impacted by many risk factors, encompassing genetic predispositions and perinatal complications. Notably, the NICU's environment is pivotal. Extended periods of immobility, invasive procedures, and the utilization of medical devices such as central venous catheters heighten the vulnerability to thrombosis in these fragile patients.