Thrombosis In Newborn Research Articles

Clinically symptomatic central venous catheter‐related deep venous thrombosis in newborns

Salonvaara M, Riikonen P, Kekomäki R, Heinonen K. Clinically symptomatic central venous catheter‐related deep venous thrombosis in newborns. Acta Pædiatr 1999; 88: 642‐6. Stockholm. ISSN 0803‐5253The objective of this study was to evaluate the incidence of clinically symptomatic central venous catheter (CVC)‐related deep venous thrombosis (DVT) in newborns and small infants and to try to identify clinical and genetic risk factors for catheter‐related DVT among children with thrombotic complications. CVC was inserted in 44 consecutive infants (age range 0‐90 d) during the period January 1990 to December 1995 in the neonatal intensive care unit (NICU) of Kuopio University Hospital in Kuopio. The symptoms of DVT were: syndrome of superior vena cava in 2, swelling at the CVC puncture site in 6 and repeated CVC obstructions in 2. The formation of DVT was verified by venography. Children with DVT (n= 10) had 26 (10‐365, in total 623) catheter days compared with 9 d (1‐155, in total 591) in patients without DVT (n = 26) (p < 0.005). The median (range) number of days from catheter insertion to diagnosis of DVT was 19 (7‐210). CVC had to be removed from 11 (25%) children due to various complications. There was no DVT‐related mortality. A positive family history with thromboembolic episodes at a young age was found in 3 of 10 families with a child suffering CVC‐related DVT. The levels of coagulation inhibitors were evaluated at the age of 9‐69 mo in all 10 (23%) children with CVC‐related DVT. We detected no deficiencies in protein S, protein C or antithrombin III. One child was heterozygous for the point mutation (R506Q) in the factor V gene known to cause activated protein C resistance (APCR). We conclude that newborns with CVC are at great risk of DVT and that the aetiology of DVT can rarely be identified via measurements of coagulation inhibitors. □Antithrombin III, central venous catheter, children, factor Vgene mutation, protein C, protein S, thrombosis

Clinically symptomatic central venous catheter-related deep venous thrombosis in newborns

The objective of this study was to evaluate the incidence of clinically symptomatic central venous catheter (CVC)-related deep venous thrombosis (DVT) in newborns and small infants and to try to identify clinical and genetic risk factors for catheter-related DVT among children with thrombotic complications. CVC was inserted in 44 consecutive infants (age range 0-90 d) during the period January 1990 to December 1995 in the neonatal intensive care unit (NICU) of Kuopio University Hospital in Kuopio. The symptoms of DVT were: syndrome of superior vena cava in 2, swelling at the CVC puncture site in 6 and repeated CVC obstructions in 2. The formation of DVT was verified by venography. Children with DVT (n = 10) had 26 (10-365, in total 623) catheter days compared with 9 d (1-155, in total 591) in patients without DVT (n = 26) (p < 0.005). The median (range) number of days from catheter insertion to diagnosis of DVT was 19 (7-210). CVC had to be removed from 11 (25%) children due to various complications. There was no DVT-related mortality. A positive family history with thromboembolic episodes at a young age was found in 3 of 10 families with a child suffering CVC-related DVT. The levels of coagulation inhibitors were evaluated at the age of 9-69 mo in all 10 (23%) children with CVC-related DVT. We detected no deficiencies in protein S, protein C or antithrombin III. One child was heterozygous for the point mutation (R506Q) in the factor V gene known to cause activated protein C resistance (APCR). We conclude that newborns with CVC are at great risk of DVT and that the aetiology of DVT can rarely be identified via measurements of coagulation inhibitors.

Urokinase treatment of neonatal aortoiliac thrombosis caused by umbilical artery catheterization: A case report

Umbilical artery catheterization is known to be associated with aortoiliac thrombosis in approximately 1% of newborns in whom catheters are placed. We describe a case of catheter-associated aortoiliac thrombosis in a newborn who was successfully treated by urokinase infusion. The infant was monitored by imaging studies followed by ultrasonography. The use of real-time ultrasonography enabled us to image this infant's aortoiliac thrombosis in an accurate, noninvasive manner and monitor the effectiveness of thrombolytic therapy. The fibrinolytic state was achieved with a combination of intravenous and intraarterial infusions of urokinase. Frequent measurement of prothrombin time, activated partial thromboplastin time, fibrinogen, and thrombin time was used to guide fibrinolytic therapy. We reviewed the literature for similar cases of aortoiliac thrombosis in newborns; some were managed by medical means, others by operation. The success rate of the two approaches appeared to be approximately equal. Therefore we recommend the less invasive approach first--urokinase therapy--to be followed by surgical intervention if thrombolysis is unsuccessful.

Urokinase treatment of neonatal aortoiliac thrombosis caused by umbilical artery catheterization: A case report

Umbilical artery catheterization is known to be associated with aortoiliac thrombosis in approximately 1% of newborns in whom catheters are placed. We describe a case of catheter-associated aortoiliac thrombosis in a newborn who was successfully treated by urokinase infusion. The infant was monitored by imaging studies followed by ultrasonography. The use of real-time ultrasonography enabled us to image this infant's aortoiliac thrombosis in an accurate, noninvasive manner and monitor the effectiveness of thrombolytic therapy. The fibrinolytic state was achieved with a combination of intravenous and intraarterial infusions of urokinase. Frequent measurement of prothrombin time, activated partial thromboplastin time, fibrinogen, and thrombin time was used to guide fibrinolytic therapy. We reviewed the literature for similar cases of aortoiliac thrombosis in newborns; some were managed by medical means, others by operation. The success rate of the two approaches appeared to be approximately equal. Therefore we recommend the less invasive approach first — urokinase therapy — to be followed by surgical intervention if thrombolysis is unsuccessful.

Transverse sinus thrombosis in newborns: clinical and magnetic resonance imaging findings.

Neonatal transverse sinus thrombosis (TST) is considered a rare and severe sequela of birth injury. Clinical descriptions of this entity are few since most published series are postmortem studies. The advent of magnetic resonance imaging (MRI) allows recognition of TST ante mortem. We describe 4 full-term infants with distinct clinical and neuroradiological features indicative of TST, which we suggest may be relatively common, with a wide spectrum of severity, including favorable outcome.

Treatment of Renal Vein Thrombosis in the Newborn

To the Editor.— We are writing to you with regard to the article by Belman et al, entitled "Non-operative Treatment of Unilateral Renal Vein Thrombosis in the Newborn" ( 211 :1165,1970). This article calls attention to a very important problem, namely renal vein thrombosis in newborns. First, we would like to point out that the conclusions reached in this article were derived from an experience with seven cases but apparently in only two instances (cases 1 and 7) was the diagnosis of renal vein thrombosis proved. Second, of the cases reported, none were either proved or presumed to have had bilateral renal vein thrombosis. However, if we interpret the last paragraph of this report correctly, Dr. Belman recommended that bilateral renal vein thrombosis also should be treated conservatively since he stated "When bilateral renal vein thrombosis is suspected as the cause of renal failure, dialysis is justified as chances for return