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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 most common 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

Signs and symptoms
 EXTREMITIESLungINTESTINE
Intestine
KIDNEY
Kidney
AORTA
Aorta
CNS
CNS
LUNG
Lung
ARTERIALPale 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
VENOUSSwelling

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
Adapted from Veldman A, et al. Vasc Health Risk Manag. 2008;4:1337-48.

References:

  1. Veldman A, et al. Thrombosis in the critically ill neonate: incidence, diagnosis, and management. Vasc Health Risk Manag. 2008;4:1337-48.

  2. Haley KM. Neonatal Venous Thromboembolism. Front Pediatr. 2017;5:136.

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