Risk Factors of Thrombosis in Hospitalized Neonates
Authors: Xiong Xiaoyun , Chen Juan 
Published: April 2023

Background Studies have shown that the neonatal fibrinolytic system has reduced activity compared with adults and older children, due to decreased plasminogen activity and increased plasma plasminogen activator inhibitor levels. Therefore, neonates are most prone to thrombosis and severe thromboembolic complications. Objectives To explore the risk factors for neonatal thrombosis. Methods A retrospective study was conducted on 87 hospitalized neonates diagnosed with neonatal thrombosis in West China Second Hospital of Sichuan University from January 2007 to April 2022. The clinical data were analyzed to determine the basic diseases, ages, genders, clinical manifestations, and other conditions of the neonates, and to evaluate the risk factors and management of thrombosis. Results The overall incidence of neonatal thrombosis was 1.41 ‰. The incidence of neonatal thrombosis increased from 0.57 ‰ in 2007 to 2.29 ‰ in 2021, showing an increasing trend year by year. Among the 87 newborns, 42 were males (48.3 %) and 45 were females (51.7 %). The male-female ratio was 1:1.12. Among them, the 33–36-weeks, ≥ 37-weeks, and 29–32-weeks gestational age groups accounted for the largest proportions, at 32.2 %, 26.4 %, and 23 % respectively. Among the 87 cases of neonatal thrombosis in children with weights 1500–2499 g, 1000–1499 g, and 2500–3499 g group accounted for the largest proportion, respectively, 35.6 %, 28.7 %, and 19.5%. Moreover, the main thrombotic sites were the limbs with 39 cases (44.8 %) and the great saphenous vein with 10 cases (11.5 %). Of these, 45 cases had a history of peripherally inserted central catheters, which may be linked to catheter-related thrombosis. In addition, among the sites of thrombosis, there were 3 cases of thrombosis within the brachial artery, 3 of the renal vein, 5 of the portal vein, 2 of the abdominal aorta, 2 of the head vein, and 2 of the radial artery, while 3 cases of embolism and 12 cases of multi-site thrombosis also occurred. Furthermore, 12 cases (13.8 %) were asymptomatic thrombosis, and 75 cases (86.2 %) were symptomatic thrombosis. The main clinical manifestations were swelling, purple, ecchymosis, etc. Risk factors associated with neonatal thrombosis included sepsis, use of a ventilator, respiratory distress syndrome, resuscitation history, congenital heart disease, operation history, maternal hormone administration, central venous catheterization, gestational age, birth weight, and platelet count. Resuscitation history, congenital heart disease, central venous catheterization, and gestational age were deemed as independent risk factors for thrombosis. Conclusions Risk factors such as, sepsis, ventilator use, respiratory distress syndrome, resuscitation history, congenital heart disease, surgical history, maternal hormone administration, central venous catheterization, gestational age, birth weight, and platelet count are associated with neonatal thrombosis. resuscitation history, congenital heart disease, central venous catheterization, and gestational age are independent risk factors for thrombosis.