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Neonatal thromboembolic events, both arterial and venous, are rare but increasingly recognised problems in tertiary care neonatology. The pathophysiology of these events in the context of the neonatal haemostatic system and the importance of both inherited and acquired prothrombotic disorders remain poorly defined. Similarly, optimal diagnostic and therapeutic approaches in this setting are not currently based on sound clinical evidence, and there is a clear need to investigate these issues, which will inevitably require large multicentre studies.J Clin Pathol 2000;53:419–423
The peak incidence of thromboembolic events in the paediatric age group occurs in neonates and infants less than 1 year of age.1 The published literature on neonatal thrombosis consists largely of case reports and small, single centre case series, and is therefore open to bias. Recently, however, two neonatal registries from Canada and Germany have collected prospective data on unselected cases from multiple centres. In the Canadian registry, the incidence of clinically apparent thrombosis (excluding stroke) was 2.4/1000 admissions to neonatal intensive care units, whereas in the German study, symptomatic thrombosis was recorded in 5.1/100 000 births.2,3
Table 1 shows the distribution of events in these two studies. Although broadly similar, there are some important differences, with the German registry recording renal vein thrombosis as the most common venous event, whereas in the Canadian study other venous events predominated. In addition, in the Canadian registry, despite the exclusion of stroke, there was a relatively high incidence of arterial events compared with the German group. The reasons for these differences are not clear, but might simply represent the relatively small numbers involved. Cerebral events were included in the German registry, where there were nine in a total of 79 arterial events with, perhaps surprisingly, no cases of sinovenous thrombosis recorded. In both studies, renal vein thrombosis tended to …
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