Navigating neonatal thrombosis: contemporary insights into a complex disorder in a unique population

Neonatal thromboembolic disease (TE) is an increasingly recognized clinical condition associated with significant morbidity, despite its relatively low incidence in the general paediatric population. Neonates-especially those in Neonatal Intensive Care Units (NICUs)-are at the highest risk for TE among all paediatric age groups. This elevated risk is attributed to the developmental characteristics of neonatal haemostasis, the frequent use of central venous catheters, and the presence of significant underlying comorbidities. Over recent decades, the reported incidence of neonatal TE has risen significantly, reflecting improvement in neonatal intensive care, and increased awareness and recognition of thrombotic complications. The unique pathophysiology of neonatal TE, and its distinct risk factors, underscore the need for a stronger neonatal-specific evidence to support prevention, diagnosis and management of thromboembolic events. The objective of this review is to summarise and critically appraise existing evidence on the epidemiology, the pathophysiology and the risk factors related to neonatal TE. It also aims to identify current knowledge gaps and areas requiring further investigation. Overall, the available evidence supports a multifactorial model of neonatal thrombosis, whereby developmental hemostasis interacts with acquired antenatal and perinatal risk factors. However, substantial heterogeneity in epidemiological data and diagnostic approaches continues to hinder accurate thrombotic risk stratification and evidence-based clinical decision-making.