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Neonatology pp 1455-1469 | Cite as

The Thrombotic Risk of the Newborn

  • Molinari Angelo Claudio
  • Paola Saracco
Reference work entry

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.

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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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Thrombosis and Hemostasis UnitGiannina Gaslini Children’s HospitalGenovaItaly
  2. 2.Pediatric Hematology, Department of PediatricsUniversity Hospital Città della Salute e della ScienzaTorinoItaly

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