Division of Neonatology, Department of Pediatrics.
Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital.
Blood Coagul Fibrinolysis. 2022 Mar 1;33(2):83-89. doi: 10.1097/MBC.0000000000001110.
The incidence of neonatal venous and arterial thrombosis ranges from 6.9 to 15/1000 neonatal ICU (NICU) admissions, and is likely an underestimate based on population demographics, frequency of surveillance and vascular catheterization. This retrospective study involving 234 infants reviewed the epidemiology, diagnosis, and management of neonatal thrombosis in a single, tertiary care institution over more than 10 years. The incidence of thrombosis was 25/1000 NICU admissions, with a preterm to term infant ratio of 1.5 : 1 and a slightly higher proportion of male sex (55.1%). The mean (range) gestational age and birth weight was 33.8 weeks (23-41.6) and 2360 g (512-5890). The median age (IQR) of thrombus diagnosis was 7 (3-17) days. Portal vein thrombosis was most prevalent (59.4%) compared with other sites of thrombosis. Almost three-quarter (171/234; 73.1%) of the thrombotic episodes were line-related, while infection and surgery were associated with 19.7% (46/234) and 10.7% (25/234), respectively. Twenty patients (8.3%) were screened for thrombophilia and 3 were positive; 2 for antithrombin deficiency, 1 for factor V Leiden gene mutation. Subjects were followed with imaging for 3 months with a treatment duration, mean (IQR) of 33.5 (10.8-42.5) days. Complete clot resolution was significantly higher in the anticoagulation group (48%; 17%; P = 0.03) compared with untreated patients. No group difference was noted for partial thrombus resolution (33.3%; 12.4%; P = 0.313). Anticoagulation halted thrombus progression (2.6 versus 12.4%; P = 0.025) and fewer treated patients failed to attend follow-up visits (6.5 versus 18.6%; P = 0.022). Well designed, multicenter prospective studies with larger sample sizes are required to confirm these findings.
新生儿动静脉血栓形成的发病率为每 1000 例新生儿重症监护病房（NICU）入院 6.9-15 例，基于人群统计学、监测频率和血管置管，这可能是一个低估的数字。这项回顾性研究涉及 234 名婴儿，研究了一家三级保健机构 10 多年来新生儿血栓形成的流行病学、诊断和治疗。血栓形成的发病率为每 1000 例 NICU 入院 25 例，早产儿与足月儿的比例为 1.5：1，男性比例略高（55.1%）。平均（范围）胎龄和出生体重为 33.8 周（23-41.6）和 2360g（512-5890）。血栓诊断的中位数（IQR）年龄为 7（3-17）天。门静脉血栓形成最为常见（59.4%），其次是其他部位的血栓形成。近四分之三（171/234；73.1%）的血栓形成事件与导管有关，而感染和手术分别与 19.7%（46/234）和 10.7%（25/234）相关。20 名患者（8.3%）接受了血栓形成倾向筛查，其中 3 名呈阳性；2 名为抗凝血酶缺陷，1 名为因子 V Leiden 基因突变。对 234 名患者进行了 3 个月的影像学随访，抗凝治疗的平均（IQR）持续时间为 33.5（10.8-42.5）天。与未治疗患者相比，抗凝组的完全血栓溶解率显著更高（48%；17%；P=0.03）。部分血栓溶解率无组间差异（33.3%；12.4%；P=0.313）。抗凝可阻止血栓进展（2.6%对 12.4%；P=0.025），较少的治疗患者未能按时进行随访（6.5%对 18.6%；P=0.022）。需要设计良好、多中心的前瞻性研究，以确认这些发现。
