Thromboembolic complications in newborns – diagnostic value of D-dimers concentration and proposed outline of enoxaparin use
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Department of Neonatology and Neonatal Intensive Care Unit, Independent Public Healthcare, Puławy, Poland
Department of Veterinary Hygiene, Provincial Veterinary Inspectorate, Lublin, Poland
Sławomir Jan Wątroba   

Department of Neonatology and Neonatal Intensive Care Unit, Independent Public Healthcare, Bema 1, 24-100 Puławy, Poland
Introduction and objective:
Among paediatric patients, thromboembolic complications (TECs) are most often observed in newborns, especially premature infants requiring intensive care and the use of central vascular accesses. Prognosis depends on the presence of comorbidities, maturity of the newborn, and the location and size of the thrombus. The basic laboratory test that allows for the exclusion of TECs is assessment of the plasma D-dimers concentration, the correct value of which sufficiently excludes the presence of TECs.

Review methods:
The review attempts to systematize existing knowledge on the plasma D-dimers concentration in newborns, and creates a scheme for using enoxaparin (EX), helpful in everyday clinical practice.

Brief description of the state of knowledge:
There are single studies devoted to assessing the plasma D-dimers concentration in newborns, but they agree that the concentration in normal healthy adults does not apply to newborns, regardless of the postmenstrual age (PMA), because the plasma D-dimers concentration found in newborns are significantly higher, despite the lack of clinical and ultrasound features of thrombosis and normal results of other parameters of the coagulation system. Increased plasma D-dimers concentration in newborns may be due to delayed renal clearance of D-dimers and to physiological mechanisms related to the closing of the venous duct (DV) and arterial duct (DA) in the newborn.

Plasma D-dimers concentration is one of the basic laboratory markers of TECs, and is a starting point for further diagnostics and a valuable guide when making decisions about prophylactic and therapeutic procedures. The use of EX, as well as other LMWHs, is slowly becoming the treatment of choice in paediatric patients and is increasingly more often recommended in newborns.

ALP – alkaline phosphatase; ALT – alanin aminotransferase; APTT – activated partial-thromboplastin time; AST – asparaginian aminotransferase; AT-3 – antithrombin-3; BT – bleeding time; CB – conjugated bilirubin; DA – ductus arteriosus; DV – ductus venosus; ELISA – enzyme-linked immunosorbent assay; EX – enoxaparin; FB – fibrinogen; FPX – fondaparinux; GC – glucocorticoids; GGTP – gamma-glutamyl transpeptidase; Hb – haemoglobin; HCT – haematocrit; HIT – heparininduced thrombocytopenia; HP – heparin; IMH – intramedullary haemorrhage; INR – international normalized ratio; IUGR – intrauterine growth retardation; LMWH – low-molecular weight heparin; LP – lumbar puncture; NFH – non-fractionated heparin; OMP – omeprazole; PMA – postmenstrual age; PT – prothrombin time; TB – total bilirubin; TCT – thrombin clotting time; TEC – thromboembolic complication; TEI – thromboembolic incident; TT – thrombolytic treatment
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