Pathogenesis, clinical features, and diagnosis of thrombosis in the newborn
- Anthony KC Chan, MBBS, FRCPC, FRCPath
Anthony KC Chan, MBBS, FRCPC, FRCPath
- Professor of Pediatrics
- McMaster University, Canada
- Mihir D Bhatt, MD
Mihir D Bhatt, MD
- Clinical Scholar, Pediatric Hematology and Oncology
- McMaster University
- Section Editors
- Donald H Mahoney, Jr, MD
Donald H Mahoney, Jr, MD
- Section Editor — Pediatric Hematology
- Professor of Pediatrics
- Baylor College of Medicine
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Thrombotic disease is uncommon in newborns. However, this disorder can cause serious morbidity. The pathogenesis, clinical features, and diagnosis of neonatal thrombosis, excluding the central nervous system (CNS), are reviewed here. CNS thromboembolic disease and the management of neonatal thrombosis are discussed separately. (See "Stroke in the newborn" and "Management of thrombosis in the newborn".)
COAGULATION IN NEWBORNS
Plasma concentrations of the components of the coagulation cascade (figure 1) and fibrinolytic pathway (figure 2) in newborns differ markedly from older children and adults. Concentrations of these factors change from birth through infancy (table 1) [1-4]. (See "Overview of hemostasis".)
In newborns, the following procoagulant, anticoagulant, and fibrinolytic factors differ considerably compared with adult levels:
●Vitamin K-dependent coagulation factors (II, VII, IX, X) and contact factors (XI, XII, prekallikrein, high molecular weight kininogen) are 50 to 70 percent of adult levels . These factors increase rapidly after birth, reaching adult levels of most components by six months of age .
●Factors V, VIII, XIII, von Willebrand factor, and fibrinogen are at least 70 percent of adult levels .
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- COAGULATION IN NEWBORNS
- Risk factors
- CLINICAL FEATURES
- Catheter-associated thrombosis
- - Venous thrombosis
- - Right atrial thrombosis
- - Arterial thrombosis
- Umbilical artery catheter
- Peripheral artery occlusion
- - Portal vein thrombosis
- Renal vein thrombosis
- Purpura fulminans
- - Clinical presentation
- - Diagnosis
- LABORATORY FINDINGS
- - Renal vein thrombosis imaging
- Coagulation studies
- SUMMARY AND RECOMMENDATIONS