DVT of the Neonate

[ali]

Hello to you all,

I am intrigued as to your current approach to the neonate with a confirmed thrombosis.

Thanks with anticipation

[Stefan Johansson]

We have no clinical protocol for deep vein trombosis, but consult the coagulation specialist in our hospital in each separate case of more complicated coagulation disorder.

In a case of a term infant with a symptomatic aortic trombosis (after a UAC) we gave dalteparin-natrium (Fragmin) in the dose of 100 units/kg twice daily (NB: we do not treat non-symptomatic aortic fibrin clots after UACs, if found accidentally during echo's, but follow those until the resolve spontaneously)

Generally (and personally) I think one need to be careful to heparinize infants due to the risk of hemorraghes, but each case needs an individual consideration.

[JACK]

We had a very frightening experience of aortic thrombosis in an infant of diabetic mother. This baby was term, had no central line, but had polycythemia.

This baby was managed successfully with a partial exchange transfusion to bring the hematocrit down and enoxaparin.

We always consult our vascular surgeons for their opinion whenever we have a case of vascular thrombosis.

We had used 1.5 mg/kg/kg of Enoxaparin given Subcutaneous route Q12h.
We did not have any complications.

The recent findings may call for higher doses:
Term: 1.7 mg/kg
Preterm: 2 mg/kg
(Janet I Malowany et al., “Enoxaparin use in the neonatal intensive care unit: experience over 8 years,” Pharmacotherapy 27, no. 9 (September 2007): 1263-71, doi:10.1592/phco.27.9.1263.)

However caution is always advised while using any type of anti-coagulants in newborn.

There has been a report of using protamine to reverse enoxaparine overdose in a neonate.
( John T Wiernikowski, Anthony Chan, and Greg Lo, “Reversal of anti-thrombin activity using protamine sulfate. Experience in a neonate with a 10-fold overdose of enoxaparin,” Thrombosis Research 120, no. 2 (2007): 303-5, doi:S0049-3848(06)00341-0.)

Also the consequences of doing a lumbar puncture on a neonate receiving enoxaparine is highlighted in this report :
Archna Gupta, John T Wiernikowski, and Anthony K C Chan, “The use of low molecular weight heparins in pediatrics: two cases that highlight potential risks to patient safety,” Thrombosis Research 121, no. 2 (2007): 281-2, doi:S0049-3848(07)00111-9.