Incidence, diagnosis, and treatment of non-central nervous system thrombosis.
| Type of Thrombosis . | Incidence . | Diagnosis . | Therapy . |
|---|---|---|---|
| Abbreviations: TE, thromboembolic event; US, ultrasound; NICU, neonatal intensive care unit; LMWH, low molecular weight heparin; UFH, unfractionated heparin; V/Q, ventilation perfusion scan; UVC, umbilical vein catheter; RVT, renal vein thrombosis; IVC, inferior vena cava; ICH, intracranial hemorrhage | |||
| 1. Systemic Venous TE | 2.4/1000 admissions to NICU 1 | Upper venous system: Intrathoracic vessels: venography sensitive198 | Treatment recommendations are not supported by strong evidence46 |
| 5.1/100,000 live births 2 | Neck vessels: US sensitive 18 | LMWH14/UFH158 or observant therapy with close monitoring are options | |
| Warfarin is not recommended in children <12 months of age unless indication is a mechanical valve 138 | |||
| Thrombolytic therapy (tPA) is recommended for therapy only if potential loss of life, organ or limb due to high incidence of hemorrhage199 | |||
| Pulmonary Embolism | 14% in a retrospective autopsy series200 | V/Q scan201 | |
| CVL-related TE | no data for neonates alone14 | Upper venous system: | Treatment: as above |
| 0-30% in infants <1 year | Intrathoracic vessels:venography sensitive198 | Prophylaxis: UFH flushes or low dose infusions (1 to 3 u/kg/hr) | |
| Neck vessels: US sensitive 18 | |||
| Right Atrial TE | No incidence data | Cardiac catheterization | Treatment: as above |
| Echocardiography | |||
| No studies comparing sensitivity and specificity have been completed. | |||
| UVC | 20-65% of infants dying with a UVC in situ14 | Contrast venography is gold standard US most commonly used | Treatment: as above |
| 13% in clinical studies 14 | No sensitivity and specificity data | Prophylaxis: UFH flushes or low dose infusions (1 to 3 u/kg/hr) | |
| Non CVL-related TE | |||
| RVT | 2.2/100,000 live births202 | Contrast venography is gold standard | Treatment is controversial |
| US most commonly used | Consider UFH/LMWH if thrombus extends to IVC or involving bilateral renal vein, or renal failure | ||
| No studies comparing sensitivity and specificity have been completed | |||
| 2. Systemic Arterial TE | |||
| A. UAC | Clinical symptoms 1-5% 40 | Contrast angiography is gold standard46 | Prophylaxis: |
| Loss of patency: | UFH concentrations as low as 0.25 u/ml can decrease the incidence of catheter occlusion162 but may not decrease aortic thrombosis | ||
| a. absence of heparin 13 to 73%40 | |||
| b. presence of heparin 0 to 13%40 | |||
| US 14 to 35%40 | |||
| Angiography up to 64%40 | |||
| Autopsy 9 to 28%40 | |||
| B. Other | No incidence data (femoral or peripheral artery) | Contrast angiography is gold standard | Prophylaxis: |
| UFH 1 u/ml prolongs patency of PACs58 | |||
| ICH not increased in use of low dose UFH185 | |||
| Complications of TE | |||
| Mortality | Highest among infants with aortic thrombosis or CVL-associated thrombosis affecting the right atrium or the superior vena cava1 | ||
| Post-phlebitic syndrome | Clinical diagnosis24 | ||
| Type of Thrombosis . | Incidence . | Diagnosis . | Therapy . |
|---|---|---|---|
| Abbreviations: TE, thromboembolic event; US, ultrasound; NICU, neonatal intensive care unit; LMWH, low molecular weight heparin; UFH, unfractionated heparin; V/Q, ventilation perfusion scan; UVC, umbilical vein catheter; RVT, renal vein thrombosis; IVC, inferior vena cava; ICH, intracranial hemorrhage | |||
| 1. Systemic Venous TE | 2.4/1000 admissions to NICU 1 | Upper venous system: Intrathoracic vessels: venography sensitive198 | Treatment recommendations are not supported by strong evidence46 |
| 5.1/100,000 live births 2 | Neck vessels: US sensitive 18 | LMWH14/UFH158 or observant therapy with close monitoring are options | |
| Warfarin is not recommended in children <12 months of age unless indication is a mechanical valve 138 | |||
| Thrombolytic therapy (tPA) is recommended for therapy only if potential loss of life, organ or limb due to high incidence of hemorrhage199 | |||
| Pulmonary Embolism | 14% in a retrospective autopsy series200 | V/Q scan201 | |
| CVL-related TE | no data for neonates alone14 | Upper venous system: | Treatment: as above |
| 0-30% in infants <1 year | Intrathoracic vessels:venography sensitive198 | Prophylaxis: UFH flushes or low dose infusions (1 to 3 u/kg/hr) | |
| Neck vessels: US sensitive 18 | |||
| Right Atrial TE | No incidence data | Cardiac catheterization | Treatment: as above |
| Echocardiography | |||
| No studies comparing sensitivity and specificity have been completed. | |||
| UVC | 20-65% of infants dying with a UVC in situ14 | Contrast venography is gold standard US most commonly used | Treatment: as above |
| 13% in clinical studies 14 | No sensitivity and specificity data | Prophylaxis: UFH flushes or low dose infusions (1 to 3 u/kg/hr) | |
| Non CVL-related TE | |||
| RVT | 2.2/100,000 live births202 | Contrast venography is gold standard | Treatment is controversial |
| US most commonly used | Consider UFH/LMWH if thrombus extends to IVC or involving bilateral renal vein, or renal failure | ||
| No studies comparing sensitivity and specificity have been completed | |||
| 2. Systemic Arterial TE | |||
| A. UAC | Clinical symptoms 1-5% 40 | Contrast angiography is gold standard46 | Prophylaxis: |
| Loss of patency: | UFH concentrations as low as 0.25 u/ml can decrease the incidence of catheter occlusion162 but may not decrease aortic thrombosis | ||
| a. absence of heparin 13 to 73%40 | |||
| b. presence of heparin 0 to 13%40 | |||
| US 14 to 35%40 | |||
| Angiography up to 64%40 | |||
| Autopsy 9 to 28%40 | |||
| B. Other | No incidence data (femoral or peripheral artery) | Contrast angiography is gold standard | Prophylaxis: |
| UFH 1 u/ml prolongs patency of PACs58 | |||
| ICH not increased in use of low dose UFH185 | |||
| Complications of TE | |||
| Mortality | Highest among infants with aortic thrombosis or CVL-associated thrombosis affecting the right atrium or the superior vena cava1 | ||
| Post-phlebitic syndrome | Clinical diagnosis24 | ||