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The Thrombotic Risk of the Newborn

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Abstract

The first weeks of life have the highest rate of thrombotic complications in the pediatric age, and thromboembolism mainly affects sick newborns. It is well known that despite low levels of procoagulant factors in the first months of life, newborns show a perfect hemostasis; this is probably due to the balancing effect of the low levels of physiological inhibitors (protein C, protein S, and antithrombin).

Some other pathophysiological insights are available to favor the knowledge of the process that pathological situations may lead newborns to experience thromboembolic complications. In the recent years, genetic prothrombotic conditions have been widely studied but their role in determining thrombosis in the neonates is still under debate. Moreover, in the sick newborn, especially preterm, several acquired perinatal and iatrogenic conditions might result in a disturbance between coagulation and fibrinolysis, leading to thrombus formation. The use of central lines, cardiac diseases and polycythemia, renal diseases such as congenital nephrotic syndrome and neonatal hemolytic uremic syndrome, peripartum asphyxia, infants of diabetic mothers, dehydration, septicemia, necrotizing enterocolitis, acute respiratory distress syndrome, and extracorporeal membrane oxygenation lead to elevated thrombin generation and subsequent thrombus formation.

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Abbreviations

ACA:

Anticardiolipin antibodies

AIS:

Arterial ischemic stroke

APA:

Antiphospholipid antibodies

APLS:

Antiphospholipid syndrome

ArT:

Arterial thrombosis

AT:

Antithrombin (natural anticoagulant)

CNS:

Central nervous system

CSVT:

Cerebral sinovenous thrombosis

CVL:

Central venous line

ETP:

Endogenous thrombin potential

FI:

Fibrinogen

FII:

Coagulation factor II

FV:

Coagulation factor V

FVII:

Coagulation factor VII

FVIII:

Coagulation factor VIII

FVL:

Factor V Leiden (prothrombotic polymorphism of FV)

FX:

Coagulation factor X

FXIII:

Coagulation factor XIII

LA:

Lupus anticoagulant

MTHFR:

Methylenetetrahydrofolate reductase

PAP:

Plasmin-alpha2-antiplasmin complex

PC:

Protein C (natural anticoagulant)

PE:

Pulmonary embolism

PLG:

Plasminogen

PRT G20210A:

Prothrombotic mutation of factor II G20210A

PS:

Protein S (natural anticoagulant cofactor of PC)

PVT:

Portal vein thrombosis

RVT:

Renal vein thrombosis

TAT:

Thrombin–antithrombin complex

TE:

Thromboembolic events

TF:

Tissue factor

TFPI:

TF pathway inhibitor

TM:

Thrombomodulin

UAC:

Umbilical artery catheter

UVC:

Umbilical vein catheter

VWF:

Von Willebrand factor

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Authors and Affiliations

  1. Thrombosis and Hemostasis Unit, Giannina Gaslini Children’s Hospital, Genova, Italy

    Molinari Angelo Claudio

  2. Pediatric Hematology, Department of Pediatrics, University Hospital Città della Salute e della Scienza, Torino, Italy

    Paola Saracco

Authors
  1. Molinari Angelo Claudio
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  2. Paola Saracco
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Correspondence to Molinari Angelo Claudio .

Editor information

Editors and Affiliations

  1. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Rodolfo Bracci

  3. Liverpool Women’s Hospital Neonatal Unit, Liverpool, UK

    Michael Weindling

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Claudio, M.A., Saracco, P. (2018). The Thrombotic Risk of the Newborn. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29489-6_239

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  • DOI: https://doi.org/10.1007/978-3-319-29489-6_239

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