Yenidoğan Trombozunda Güncel Yaklaşımlar

Öz

Yenidoğanda hemostatik sistemdeki fizyolojik özelliklere ek olarak kalıtsal veya kazanılmış protrombotik risk faktörlerinin varlığı tromboza eğilime neden olmaktadır. Prematüre ve hasta yenidoğanların yaşama oranının artması nedeniyle yoğun bakım tedavisi ve izlemi ile ilişkili komplikasyonların görülme sıklığı da artmıştır. Trombotik komplikasyonlar asemptomatik olabileceği gibi organ kaybına neden olan bir klinik tablo ile de sonuçlanabilir. Bu nedenle, yenidoğan döneminde trombozun erken dönemde tanınması ve uygun tedavinin planlanması önemlidir. Bu yazıda, yenidoğan trombozu ile ilgili güncel bilgilerin literatürler ışığında irdelenmesi amaçlandı.

Anahtar Kelimeler

• Yenidoğan, tromboz, risk faktörleri, tedavi

CURRENT OPINIONS ON NEONATAL THROMBOSIS

Öz

Both physiologic characteristics of the haemostatic system during the neonatal period and hereditary or acquired prothrombotic risk factors make newborn prone to thrombosis. As survival of premature and sick newborns has improved, the frequency of complications associated with intensive supportive therapy and monitoring has increased. Thrombotic complications may be asymptomatic or result in severe organ damage. Therefore, early diagnosis and appropriate management of the neonatal thrombosis are essential. This is review challenging current opinions on neonatal thrombosis with literature highlight

Anahtar Kelimeler

• Newborn, thrombosis, risk factors, management

Kaynakça

1. Nowak-Göttl U, von Kries R, Göbel U. Neonatal symptomatic thromboembolism in Germany: two year survey. Arch Dis Child Fetal Neonatal Ed 1997;76:163-167.
2. Schmidt B, Andrew M. Neonatal thrombosis: Report of a prospec- tive Canadian and International registry. Pediatrics 1995;96:939- van Ommen CH, Heijboer H, Büller HR, Hirasing RA, Heijmans
3. HS, Peters M. Venous thromboembolism in childhood: a prospec- tive two year registry in the Netherlands. J Pediatr 2001;139:676
4. Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood ;80:1998–2005.
5. Nowak-Göttl U, Kosch A, Schlegel N. Neonatal thromboembo- lism. Semin Thromb Haemost 2003;29:227-234.
6. Pipe SW, Schmaier AH, Nichols WC, Ginsburg D, Bozynski ME, Castle VP. Neonatal purpura fulminans in association with factor V R506Q mutation. J Pediatr 1996;128:706-709.
7. Williams MD, Chalmers EA, Gibson BE. Haemostasis and Thrombosis Task Force, British Committee for Standards in Ha- ematology. The investigation and management of neonatal hae- mostasis and thrombosis. Br J Haematol 2002;119:295-309.
8. Stanworth SJ, Bennett C. How to tackle bleeding and thrombosis in the newborn. Early Hum Dev 2008;84:507-513.

9. Greenway A, Massicotte MP, Monagle P. Neonatal thrombosis and its treatment. Blood Rev 2004;18:75-84.
10. Massicotte MP, Dix D, Monagle P, Adams M, Andrew M. Cent- ral venous catheter related thrombosis in children: analysis of the Canadian registry of venous thromboembolic complications. J Pediatr 1998;133:770-776.
11. Tanke RB, van Megen R, Daniels O. Thrombus detection on cent- ral venous catheters in the neonatal intensive care unit. Angiology ;45:477-480. Kürekçi E, Kaye R, Koehler M. Chylothorax and chyloperi- cardium: complication of a central venous catheter. J Pediatr ;132:1064-1066.
12. Manco-Johnson MJ: How I treat venous thrombosis in children. Blood 2006;107:21-29.
13. Kuhle S, Massicotte P, Chan A, Mitchell L. A case series of 72 neonates with renal vein thrombosis. Data from the 1-800-NO- CLOTS Registry. Thromb Haemost 2004;92:729-733.
14. Barnes C, Newall F, Monagle P. Post-thrombotic syndrome. Arch Dis Child 2002;86:212-214.
15. Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umbi- lical vein catheterization lead to portal venous thrombosis? Pros- pective US evaluation in 100 neonates. Radiology 2001;219:645
16. Sakha SH, Rafeey M, Tarzamani MK. Portal venous thrombo- sis after umbilical vein catheterization. Indian J Gastroenterol ;26:283-284. Thornburg C, Pipe S. Neonatal thromboembolic emergencies. Se- min Fetal Neonatal Med 2006;11:198-206. deVeber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley
17. DJ, Camfield CS, David M, Humphreys P, Langevin P, MacDonald EA, Gillett J, Meaney B, Shevell M, Sinclair DB, Yager J; Canadi- an Pediatric Ischemic Stroke Study Group. Cerebral sinovenous thrombosis in children. N Engl J Med 2001;345:417-423.
18. Golomb MR, Dick PT, MacGregor DL, Curtis R, Sofronas M, deVeber GA. Neonatal arterial ischemic stroke and cerebral si- novenous thrombosis are more commonly diagnosed in boys. J Child Neurol 2004;19:493-497.
19. Atasay B, Arsan S, Gunlemez A, Kemahli S, Akar N. Factor V Le- iden and prothrombin gene 20210A variant in neonatal thrombo- embolism and in healthy neonates and adults: A study in a single center. Pediatr Hematol Oncol 2003;20:627-634.
20. Berman Jr W, Fripp RR, Yabek SM, Wernly J, Corlew S. Great vein and right atrial thrombosis in critically ill infants and children with central venous lines. Chest 1991;99:963-967.
21. Andrew ME, Monagle P, deVeber G, Chan AK. Thromboembo- lic disease and antithrombotic therapy in newborns. Hematology Am Soc Hematol Educ Program] 2001:358-374.
22. Shah PS, Shah VS. Continuous heparin infusion to prevent throm- bosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database Syst Rev 2008;16:2772.
23. Monagle P, Chan A, Massicotte P, Chalmers E, Michelson AD. Antithrombotic therapy in children: the Seventh ACCP Con- ference on Antithrombotic and Thrombolytic Therapy. Chest ;126:645-687. onal Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics 2002;109:116-123. homozygous protein C or protein S deficiencies. Semin Thromb Hemost 1990;16:299-309.
24. J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. Evalutation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003;349:1227-1235. untain States Regional Thrombophilia Group. Elevated plasma factor VIII and D-dimer levels as predictors of poor outcomes of thrombosis in children. N Engl J Med 2004;351:1081-1088. lism in children. Pediatr Radiol 2005;35 258-274.
25. Gürgey A, Kuşkonmaz B. Çocuklarda antitrombotik tedavi. Katkı Pediatri Dergisi 2007; 29:485-520.
26. Risch L, Fischer JE, Herklotz R, Huber AR. Heparin-induced thrombocytopenia in paediatrics: clinical characteristics, therapy and outcomes. Intensive Care Med 2004;30:1615-1624.
27. Goldenberg NA, Durham JD, Knapp-Clevenger R, Manco- Johnson MJ. A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood 2007;110:45-53.
28. Balasa VV. New anticoagulants: a pediatric perspective. Pediatr Blood Cancer 2005;45:741-752.
29. Weitz JI, Hirsh J, Samama MM. New antithrombotic drugs: Ame- rican College of Chest Physicians Evidence-Based Clinical Practi- ce Guidelines (8th Edition). Chest 2008;133:234-256.