Paola Saracco1, Rossana Bagna2, Chiara Gentilomo3, Mariella Magarotto4, Alice Viano5, Federica Magnetti2, Paola Giordano6, Matteo Luciani7, Angelo Claudio Molinari8, Agnese Suppiej9, Luca Antonio Ramenghi10, Paolo Simioni11. 1. Pediatric Hematology, Department of Pediatrics, University Hospital Città della Salute e della Scienza, Torino, Italy. Electronic address: paola.saracco@unito.it. 2. Neonatal Intensive Care Unit, Department of Obstetrics and Neonatology, University Hospital Città della Salute e della Scienza, Torino, Italy. 3. Department of Pediatrics, Dell'Angelo Hospital, Venezia, Italy. 4. Neonatal Intensive Care Unit, Pediatrics, University Hospital of Padova, Padova, Italy. 5. Department of Pediatric Sciences, University Hospital Città della Salute e della Scienza, Torino, Italy. 6. Pediatric Hematology and Oncology, University of Bari, Bari, Italy. 7. Department of Hematology and Oncology and Transfusional Medicine, IRCCS Pediatric Hospital Bambin Gesù, Roma, Italy. 8. Thrombosis and Hemostasis Unit, Giannina Gaslini Children Hospital, Genova, Italy. 9. Child Neurology Unit, Pediatric University Hospital of Padova, Padova, Italy. 10. Neonatal Intensive Care Unit, Giannina Gaslini Children Hospital, Genova, Italy. 11. Department of Medicine, Coagulation Diseases Unit, University of Padova Medical School, Padova, Italy.
Abstract
OBJECTIVE: To evaluate clinical data and associated risk conditions of noncerebral systemic venous thromboembolism (VT), arterial thromboembolism (AT), and intracardiac thromboembolism (ICT) in neonates. STUDY DESIGN: Data analysis of first systemic thromboembolism occurring in 75 live neonates (0-28 days), enrolled in the Italian Registry of Pediatric Thrombosis from neonatology centers between January 2007 and July 2013. RESULTS: Among 75 events, 41 (55%) were VT, 22 (29%) AT, and 12 (16%) ICT; males represented 65%, and 71% were preterm. In 19 (25%), thromboembolism was diagnosed on the first day of life. In this "early onset" group, prenatal-associated risk conditions (maternal/placental disease) were reported in 70% and inherited thrombophilia in 33%. Postnatal risk factors were present in 73%; infections and central vascular catheters in 56% and 54% VT, respectively, and in 67% ICT vs 27% AT (<.05). Overall mortality rate was 15% and significant thromboembolism-related sequelae were reported in 16% of discharged patients. CONCLUSIONS: This report from the Registro Italiano Trombosi Infantili, although limited by representing an uncontrolled case series, can be used to develop future clinical trials on appropriate management and prevention of neonatal thrombosis, focusing on obstetrical surveillance and monitoring of critically ill neonates with vascular access. A thrombosis risk prediction rule specific for the neonatal population should be developed through prospective controlled studies.
OBJECTIVE: To evaluate clinical data and associated risk conditions of noncerebral systemic venous thromboembolism (VT), arterial thromboembolism (AT), and intracardiac thromboembolism (ICT) in neonates. STUDY DESIGN: Data analysis of first systemic thromboembolism occurring in 75 live neonates (0-28 days), enrolled in the Italian Registry of Pediatric Thrombosis from neonatology centers between January 2007 and July 2013. RESULTS: Among 75 events, 41 (55%) were VT, 22 (29%) AT, and 12 (16%) ICT; males represented 65%, and 71% were preterm. In 19 (25%), thromboembolism was diagnosed on the first day of life. In this "early onset" group, prenatal-associated risk conditions (maternal/placental disease) were reported in 70% and inherited thrombophilia in 33%. Postnatal risk factors were present in 73%; infections and central vascular catheters in 56% and 54% VT, respectively, and in 67% ICT vs 27% AT (<.05). Overall mortality rate was 15% and significant thromboembolism-related sequelae were reported in 16% of discharged patients. CONCLUSIONS: This report from the Registro Italiano Trombosi Infantili, although limited by representing an uncontrolled case series, can be used to develop future clinical trials on appropriate management and prevention of neonatal thrombosis, focusing on obstetrical surveillance and monitoring of critically ill neonates with vascular access. A thrombosis risk prediction rule specific for the neonatal population should be developed through prospective controlled studies.
Authors: Denis N Silachev; Kirill V Goryunov; Margarita A Shpilyuk; Olga S Beznoschenko; Natalya Y Morozova; Elizaveta E Kraevaya; Vasily A Popkov; Irina B Pevzner; Ljubava D Zorova; Ekaterina A Evtushenko; Natalia L Starodubtseva; Alexey S Kononikhin; Anna E Bugrova; Evgeniy G Evtushenko; Egor Y Plotnikov; Dmitry B Zorov; Gennady T Sukhikh Journal: Cells Date: 2019-03-19 Impact factor: 6.600