Clinical diagnosis, treatment, and outcomes of seven neonates with deep venous thrombosis of the extremities and torso / 中华围产医学杂志

ABSTRACT

Objective:To analyze the diagnosis, treatment, and outcomes of neonates with deep venous thrombosis (DVT) of the extremities and torso.Methods:The clinical diagnosis, treatment and outcomes of seven neonates with DVT of the extremities and torso admitted to Beijing Children's Hospital, Capital Medical University from March 2016 to March 2020 were retrospectively analyzed. Paired t test and paired rank sum test were used to compare the difference of coagulation indexes before and after the anticoagulant therapy. Results:Among the seven neonates with DVT of the extremities and torso, six were male and five were term infants, with the gestational age of (37.9±2.5) weeks and birth weight of (2 989±619) g. The median age at admission was 2.0 d and the age at diagnosis was 3.0 d. Except for one case of left common femoral vein thrombosis with limb swelling on the affected side, the other cases were all found with DVT by routine abdominal ultrasound examination after admission. Six cases received heparin treatment with the median duration of 8.5 d (1.8-28.8 d), including four cases of thrombosis in the portal venous, one in the postcava and renal venous, and one in the left common femoral vein. Among the six cases, the thrombus disappeared in five cases, which were confirmed by vascular ultrasound examination during follow-up, and in another case, the thrombus was shrinked significantly but remained. After the treatment, the platelet count [(464.5±128.9)×10 9/L vs (142.5±104.2)×10 9/L, t=－5.019, P=0.004] and antithrombin-Ⅲ level [(67.08±28.87)% vs (46.05±12.60)%, Z=－2.201, P=0.028] were increased and the D-dimers was decreased [0.392 mg/L(0.250-0.884 mg/L) vs 2.511 mg/L(0.755-14.033 mg/L), Z=－2.201, P=0.028] with no reports of heparin-related side-effect. One case with advanced postcaval thrombosis did not receive heparin anticoagulant therapy, but the thrombosis disappeared 270 d after diagnosis during follow-up. Conclusions:DVT of the extremities and torso may have no specific symptoms during the neonatal period and the overall prognosis is good. Heparin anticoagulant therapy is recommended until thrombosis disappears for patients with large thrombosis or significantly high level of D-dimer. The course of heparin treatment varies greatly among individuals, and close monitoring is required.