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A Fragile Balance: Combined Thrombosis and Bleeding Disorders in Neonates
Sarina Levy-Mendelovich1, Gili Kenet1
1Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Seminars in Thrombosis and Hemostasis
|May 14, 2026
Summary
Neonates face high risks of both bleeding and thrombosis due to developmental immaturity and critical care. This review covers pathophysiology, diagnosis, and treatment for these complex coagulopathies in newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Critical Care Medicine
Background:
- Combined thrombosis and bleeding disorders present complex challenges in neonates, particularly in neonatal intensive care units (NICUs).
- These conditions are exacerbated by environmental factors and medical interventions common in NICU settings.
- Neonatal hemostasis, coupled with developmental immaturity, creates a unique predisposition to both thromboembolic events and hemorrhage.
Purpose of the Study:
- To provide a comprehensive overview of thrombosis and bleeding disorders in neonates.
- To explore the pathophysiology, clinical manifestations, diagnostic challenges, and therapeutic strategies for these conditions.
- To highlight emerging research and potential advancements for improving outcomes in this vulnerable population.
Main Methods:
- This study is a narrative review of existing literature.
- It synthesizes information on the intersection of bleeding and thrombosis in neonatal populations.
- Focuses on critically ill children, neonates, and those with inherited or acquired coagulopathies.
Main Results:
- Venous thromboembolism (VTE) affects 2-3% of NICU patients, often linked to sepsis and catheters.
- Intracranial hemorrhage is a major cause of mortality and morbidity in preterm neonates.
- Neonatal hemostasis presents unique challenges, increasing the risk of both bleeding and thrombosis.
Conclusions:
- Effective management of combined thrombosis and bleeding disorders in neonates requires a nuanced understanding of their pathophysiology and risk factors.
- Early diagnosis and tailored treatment strategies are crucial for improving outcomes.
- Further research is needed to advance therapeutic options for neonatal coagulopathies.
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