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Anticoagulant therapy by continuous heparinization in newborn and older infants
Insights
Newborn infants require higher heparin doses than adults for effective anticoagulation. Studies show specific doses achieve therapeutic heparin levels and resolve thrombosis with minimal complications.
Area of Science:
- Pediatric pharmacology
- Hematology
- Neonatal medicine
Background:
- Large vessel thromboses pose significant risks in infants and young children.
- Understanding heparin metabolism and efficacy in pediatric populations is crucial for treatment.
- Limited data exists on optimal heparin dosing and monitoring in neonates.
Purpose of the Study:
- To evaluate the metabolism and anticoagulant effect of heparin in newborn infants and young children.
- To determine appropriate heparin dosages for achieving therapeutic levels and clinical resolution of thrombosis.
- To assess the safety and efficacy of continuous intravenous heparinization in this age group.
Main Methods:
- Monitoring of 15 infants receiving continuous intravenous heparin for large vessel thromboses.
- Measurement of plasma heparin levels to assess therapeutic range (0.3 to 0.5 U/ml).
- Evaluation of micro whole blood clotting time as a monitoring tool.
Main Results:
- Higher heparin clearance rates were observed in infants with more significant thromboses.
- Heparin doses of 16 to 35 U/kg/hour (mean 27 U/kg/hour) achieved therapeutic levels and thrombus resolution.
- Micro whole blood clotting time proved to be a useful indicator of heparin effect.
- One infant experienced excessive oozing from puncture sites; otherwise, no major complications were noted.
Conclusions:
- Newborn infants may require higher heparin doses compared to adults for adequate anticoagulation.
- Continuous intravenous heparinization can be effective and safe for treating large vessel thromboses in pediatric patients.
- Micro whole blood clotting time is a valuable bedside tool for monitoring heparin therapy in infants.
Abstract:
In order to evaluate the metabolism and anticoagulant effect of heparin in the newborn infant and young child, 15 babies were monitored during continuous intravenous heparinization for documented large vessel thromboses. Infants with the most significant thromboses had the highest clearance rates for heparin. Plasma heparin levels in the therapeutic range (0.3 to 0.5 U/ml) and clinical resolution of the thrombi were associated with heparin doses of 16 to 35 U/kg/hour (mean = 27 U/kg/hour). A micro whole blood clotting time was evaluated and shown to be a useful guide to heparin effect in these infants. With the exception of excessive oozing from puncture sites in one infant, no complications of heparin therapy were noted. The newborn infant appears to require a larger amount of heparin than adults in order to achieve adequate heparinization.