Bhatt Mihir D, Chan Anthony Kc
Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
Fac Rev. 2021 Feb 25;10:20. doi: 10.12703/r/10-20. eCollection 2021.
The incidence of thrombotic disorders in neonates and children is increasing with advances in diagnostic modalities, supportive care, and management of many health conditions. The developing coagulation system, need for intensive care, including catheterization, and co-morbid conditions are responsible for the relatively high risk of thrombosis in neonates compared to older children. This review addresses the advances over the last 3 years in neonatal thrombosis, with a focus on epidemiology, cerebral sinovenous thrombosis (CSVT), renal vein thrombosis (RVT), and portal vein thrombosis (PVT). The incidence of neonatal thrombosis in the contemporary era is reported to be 6.9-15 per 1,000 neonatal intensive care unit (NICU) admissions, compared to 2.4 per 1,000 NICU admissions reported in older registry data. The majority of recently published studies are small, retrospective, and from single centers, albeit they emphasize the need for definitive data to support the efficacy and safety of anticoagulation therapy (ACT) in the management of CSVT, RVT, and PVT. We highlight two important international initiatives geared towards improving the evidence base for these conditions. The International Pediatric Thrombosis Network (IPTN) is a collaboration of 74 centers across 27 countries (as of January 2021) which has started important projects like the international neonatal RVT registry, while the International Pediatric Stroke Study (IPSS) group is in the planning stages of a randomized controlled trial to evaluate the utility of ACT in the management of neonatal CSVT.
随着诊断方式、支持治疗以及多种健康状况管理的进步，新生儿和儿童血栓性疾病的发病率正在上升。与大龄儿童相比，新生儿发育中的凝血系统、包括导管插入术在内的重症监护需求以及合并症导致其血栓形成风险相对较高。本综述阐述了过去3年新生儿血栓形成方面的进展，重点关注流行病学、脑静脉窦血栓形成（CSVT）、肾静脉血栓形成（RVT）和门静脉血栓形成（PVT）。据报道，当代新生儿血栓形成的发病率为每1000例新生儿重症监护病房（NICU）入院病例中有6.9 - 15例，而旧登记数据显示每1000例NICU入院病例中有2.4例。尽管最近发表的大多数研究规模较小、属于回顾性研究且来自单一中心，但它们强调需要确凿数据来支持抗凝治疗（ACT）在CSVT、RVT和PVT管理中的有效性和安全性。我们重点介绍了两项旨在改善这些病症证据基础的重要国际倡议。国际儿科血栓形成网络（IPTN）是一个由27个国家的74个中心组成的合作组织（截至2021年1月），它启动了诸如国际新生儿RVT登记等重要项目，而国际儿科卒中研究（IPSS）小组正处于一项随机对照试验的规划阶段，以评估ACT在新生儿CSVT管理中的效用。
