Neonatal Venous Thromboembolism.
Neonatal Venous Thromboembolism.
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DOI：
10.3389/fped.2017.00136
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发表时间：
2017
影响因子：
2.6
通讯作者：
Haley KM
中科院分区：
文献类型：
--
作者：
Haley KM
新生儿是儿童发生静脉血栓栓塞症(VTE)的高危人群，其发病率在新生儿人群中呈上升趋势。在病情危重的人群中尤其如此。几项大型研究表明，在过去的二十年里，新生儿静脉血栓栓塞症的发病率几乎增加了三倍。中心线、液体波动、脓毒症、肝功能障碍和炎症是患病新生儿发生VTE的危险因素。此外，新生儿的止血系统不同于年龄较大的儿童和成年人。血小板功能、促凝血和抗凝蛋白浓度以及纤溶途径蛋白浓度受发育调节，并产生新生儿时期独有的止血稳态。危重新生儿的临床表现加上生理上独特的新生儿止血系统，很容易符合Virchow三联症静脉淤滞、高凝和内皮损伤的标准，并将新生儿置于VTE发展的风险中。新生儿静脉血栓栓塞症的表现与年龄较大的儿童或成人相似，并取决于静脉血栓栓塞症的位置。超声是识别新生儿静脉血栓栓塞症最常用的诊断工具，但新生儿相对较小的血管以及频繁的低脉压会使超声变得不那么可靠。新生儿人群中血栓形成障碍的诊断不太可能改变治疗方法或结果，而血栓检测在这一人群中的作用还需要进一步研究。新生儿静脉血栓栓塞症的治疗旨在减少静脉血栓栓塞症相关的发病率和死亡率。然而，治疗建议不能从针对年龄较大的儿童或成年人的指南中推断出来。新生儿有出血并发症的风险，特别是年龄较小的新生儿，他们的颅内血管更脆弱。在推荐VTE治疗时，还必须考虑凝血蛋白的发育变化以及独特的药代动力学。本文将对新生儿静脉血栓形成的流行病学、新生儿静脉血栓形成的病理生理学、新生儿静脉血栓形成的诊断评价以及新生儿静脉血栓形成的治疗指南进行综述。
Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE), and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow’s triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the coagulation proteins as well as unique pharmacokinetics must also be taken into consideration when recommending VTE treatment. In this review, epidemiology of neonatal VTE, pathophysiology of neonatal VTE with particular attention to the developmental hemostatic system, diagnostic evaluations of neonatal VTE, and treatment guidelines for neonatal VTE will be reviewed.