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The Hemostatic System in Newborns and the Risk of Neonatal Thrombosis
Jamilya Khizroeva1, Alexander Makatsariya1, Alexander Vorobev1
1Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia.
Insights
Neonatal thrombosis, a serious risk for newborns, is influenced by unique hemostatic system differences. Central catheters and sepsis are key triggers, with low-molecular-weight heparins being the preferred treatment.
Area of Science:
- Pediatric Hematology
- Neonatal Critical Care
- Thrombosis Research
Background:
- Neonates are highly susceptible to thrombosis, particularly critically ill and premature infants.
- Advancements in neonatal care have increased survival rates, leading to a rise in detected neonatal thrombosis.
- Physiological differences in the hemostatic system of neonates compared to adults contribute to this vulnerability.
Purpose of the Study:
- To summarize the unique hemostatic system characteristics in neonates that predispose them to thrombosis.
- To identify the primary risk factors triggering thrombosis in newborns.
- To outline current therapeutic recommendations for neonatal thrombosis.
Main Methods:
- Review of existing literature on neonatal hemostasis and thrombosis.
- Analysis of physiological differences between neonatal and adult coagulation systems.
- Identification and categorization of neonatal thrombosis risk factors.
Main Results:
- Neonates exhibit distinct coagulation factor levels, turnover rates, and regulatory capacities compared to adults.
- Key risk factors for neonatal thrombosis include central venous catheters, fluid imbalances, liver dysfunction, and sepsis.
- Neonatal hemostasis has a reduced buffer capacity, making it prone to developing thrombosis, with approximately 95% of cases being provoked.
Conclusions:
- The unique hemostatic profile of neonates, coupled with specific risk factors, significantly increases their susceptibility to thrombosis.
- Prompt recognition and management of risk factors are crucial for preventing neonatal thrombosis.
- Low-molecular-weight heparins are established as the primary anticoagulant therapy for neonatal thrombosis.
Abstract:
Newborns are the most vulnerable patients for thrombosis development among all children, with critically ill and premature infants being in the highest risk group. The upward trend in the rate of neonatal thrombosis could be attributed to progress in the treatment of severe neonatal conditions and the increased survival in premature babies. There are physiological differences in the hemostatic system between neonates and adults. Neonates differ in concentrations and rate of synthesis of most coagulation factors, turnover rates, the ability to regulate thrombin and plasmin, and in greater variability compared to adults. Natural inhibitors of coagulation (protein C, protein S, antithrombin, heparin cofactor II) and vitamin K-dependent coagulation factors (factors II, VII, IX, X) are low, but factor VIII and von Willebrand factor are elevated. Newborns have decreased fibrinolytic activity. In the healthy neonate, the balance is maintained but appears more easily converted into thrombosis. Neonatal hemostasis has less buffer capacity, and almost 95% of thrombosis is provoked. Different triggering risk factors are responsible for thrombosis in neonates, but the most important risk factors for thrombosis are central catheters, fluid fluctuations, liver dysfunction, and septic and inflammatory conditions. Low-molecular-weight heparins are the agents of choice for anticoagulation.
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