Thrombotic events in the neonatal period – a case series of common manifestations

M. Rohde, V. Vaillant, H. Ehrhardt, K.-P. Zimmer, B. Kemkes-Matthes, C. Mauz-Körholz, H. Hauch (Giessen, Germany)

Pediatric and neonatal thrombosis and hemostasis
Date: 17.02.2017,
Time: 17:15 - 18:15

Objective: Thromboembolic events are rare in childhood, however there are certain manifestations that are well known in the neonatal period. Risk factors include infections, congenital heart disease and central catheter lines, while primary hemostatic disorders are not often diagnosed as underlying cause.

Methods: Here we present four cases and discuss respective treatment recommendations according to Chest Guideline Recommendation (CGR) as published in Chest 2012.

Results: Case 1) Male mature newborn with postnatal seizures. Imaging (ultrasound/MRI) revealed intraventricular hemorrhage grade III and sinus vein thrombosis. Dalteparin s.c. was established for 3 months. Sinus vein was well perfused without signs of persisting thrombosis in a follow-up MRI. CGR: UFH/LMWH, 6 weeks – 3 months. Case 2) Male mature newborn with early-onset sepsis and hematuria. Ultrasound showed thrombosis of left renal vein, parts of the right renal vein, the left common iliac vein, subtotal occlusion of the inferior vena cava and a floating tip reaching up to the right atrium. Treatment with tPa and UFH for 48 hours and maintenance with Dalteparin for 6 months. Thrombus was finally dissolved, however the left kidney remained without function. CGR: UFH/LMWH or initial tPA with UFH/ LMWH, 6 weeks – 3 months Case 3) In a female fetus an ascites of unknown origin was diagnosed by prenatal ultrasound at 37th week of gestation. On day 9 after caesarian birth the girl developed sudden cardio-respiratory failure. Ultrasound showed a large thrombus in the lower cava inferior. Clinical diagnosis of partial pulmonary embolism was made. Treatment with Enoxaparin s.c. was established. Clinical outcome is to be evaluated. CGR: UFH/LMWH, 6 weeks – 3 months Case 4) A male newborn preterm at 34 weeks was diagnosed with VACTERL syndrome. In routine ultrasound a large catheter-associated thrombus in the vena cava inferior with a fluctuating tip in the right atrium was shown. Treatment with UFH and maintenance with Enoxaparin. The fluctuating tip dissolved, however the vena cava inferior part of the thrombus remained unchanged. CGR: UFH/LMWH, 6 weeks – 3 months.

Conclusion: Presented cases show typical manifestations of thrombotic events during the neonatal period. Recommended treatment is most often based on UFH/LMWH therapy. Guidelines as published in Chest 2012 are helpful for clinical treatment decisions.