Rashish Galit, Paes Bosco A, Nagel Kim, Chan Anthony K, Thomas Sumesh
aFaculty of Health Sciences, McMaster University bHamilton Health Sciences, Divisions of Neonatology and Hematology and Oncology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada.
Blood Coagul Fibrinolysis. 2013 Dec;24(8):787-97. doi: 10.1097/MBC.b013e3283646673.
Neonatal spontaneous arterial thromboembolism is a rare phenomenon with a high risk of morbidity and mortality. Currently, there is little information regarding common risk factors, diagnostic strategies, therapeutic interventions, and outcomes of this condition. The objective was to nucleate the best evidence regarding the disorder in order to facilitate early detection and treatment recommendations and document adverse outcomes. Web of Science, PubMed, Medline, CINAHL, Cochrane Databases, DARE, and OVID databases were searched using the following keywords: 'arterial' AND 'thrombus' OR 'thrombosis' OR 'thromboembolism' OR 'embolism' AND 'spontaneous' AND 'at birth' OR 'newborn' OR 'neonatal' OR 'fetal' AND 'umbilical cord' OR 'umbilical wall necrosis' AND 'coagulation abnormality' OR 'placenta bits' OR 'ischemic limbs'. The search yielded 172 articles, all of which were case series or single case descriptions. Twenty-seven met inclusion criteria, with a total of 53 newborns and 30 newborn pathology reports. Ultrasound was the preferred method of diagnosis and thromboembolic locations varied with the most common site being umbilical, resulting in embolism and vascular compromise. Treatment interventions and drug dosages were not standardized and ranged from use of anticoagulants to surgery and hyperbaric oxygen. The reported mortality rate was 32.8%. Recurring etiological features facilitated identification of possible sequences of events contributing to the disorder. The literature lacks empirical evidence to affirm causes and predisposing risk factors for timely diagnosis and effective treatment of spontaneous neonatal arterial thromboembolism. Further research is needed to clearly establish the causes and the efficacy of specific treatment options.
新生儿自发性动脉血栓栓塞是一种罕见现象，具有较高的发病和死亡风险。目前，关于这种疾病的常见风险因素、诊断策略、治疗干预措施及预后的信息很少。目的是收集有关该疾病的最佳证据，以便促进早期检测和治疗建议，并记录不良后果。使用以下关键词在科学网、PubMed、Medline、CINAHL、Cochrane数据库、DARE和OVID数据库中进行检索：“动脉”与“血栓”或“血栓形成”或“血栓栓塞”或“栓塞”以及“自发性”和“出生时”或“新生儿”或“胎儿”以及“脐带”或“脐壁坏死”以及“凝血异常”或“胎盘碎片”或“肢体缺血”。检索结果为172篇文章，均为病例系列或单病例描述。27篇符合纳入标准，共有53例新生儿及30份新生儿病理报告。超声是首选的诊断方法，血栓栓塞部位各不相同，最常见的部位是脐部，可导致栓塞和血管受损。治疗干预措施和药物剂量未标准化，范围从使用抗凝剂到手术及高压氧治疗。报告的死亡率为32.8%。反复出现的病因特征有助于识别导致该疾病的可能事件序列。文献缺乏实证证据来确定新生儿自发性动脉血栓栓塞的病因和易患风险因素，以便及时诊断和有效治疗。需要进一步研究以明确病因及特定治疗方案的疗效。
