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Treatment and follow-up of venous thrombosis in the neonatal intensive care unit: a retrospective study

Journal of Perinatology volume 37, pages 306–310 (2017)Cite this article

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Abstract

Objective:

The critically ill, premature patients of neonatal intensive care units are susceptible to venous thrombosis, an adverse event associated with short- and long-term morbidity. Venous thrombosis is frequently treated with low-molecular-weight heparins (LMWHs) such as enoxaparin, but optimal dosing of LMWH must balance the morbidity of venous thrombosis with the potential adverse affects of anticoagulation. The optimal dosing of enoxaparin for premature infants is unclear. The objective of this study was to describe enoxaparin therapy and follow-up in critically ill neonates diagnosed with venous thrombosis.

Study Design:

Retrospective medical record review in the neonatal intensive care unit (NICU) in a single tertiary care institution. Infants with venous thrombosis diagnosed in the NICU were identified using preexisting quality improvement lists and medical records.

Results:

Twenty-six infants with 30 venous thromboses were identified with a median gestational age of 31 weeks at birth. Eighteen (69%) infants received enoxaparin for venous thrombosis during their hospitalization, beginning with a median dose of 1.5 mg kg−1 every 12 h. This dose was increased to a median of 2.1 mg kg−1 every 12 h to achieve target anti-factor Xa levels. The target dose was significantly higher in patients with a postmenstrual age of <37 weeks. Enoxaparin treatment was documented after discharge in 12 patients, continuing for a median of 99 days. Four patients died during hospitalization and their deaths were not attributable to venous thrombosis or anticoagulation complication. Follow-up documentation between 6 and 24 months after venous thrombosis diagnosis revealed no major morbidity of venous thrombosis or enoxaparin therapy.

Conclusion:

Our data reinforce the relative safety and necessity of enoxaparin doses above 1.5 mg kg−1 per 12 h in most neonates. This was particularly true for infants at lower postmenstrual age.

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Acknowledgements

We acknowledge the CHP Data Warehouse and the UPMC and University of Pittsburgh’s CARe who provided data for this project. We thank the Clinical and Translational Science Institute of the University of Pittsburgh for their assistance with statistical analysis. JCB is supported by the University of Pittsburgh Dean’s Summer Research Scholarship. RKA is supported by R01GM098474 from the National Institutes of Health. MG is supported by K08DK101608 from the National Institutes of Health and the Children’s Hospital of Pittsburgh of the UPMC Health System. Data analysis was performed by the Clinical and Translational Science Institute and was supported by the National Institutes of Health through Grant Number UL1TR001857.

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Authors and Affiliations

  1. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    J C Bohnhoff, R K Aneja, Y A Domnina, B S Brozanski & M Good

  2. Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA,

    S A DiSilvio, B S Brozanski & M Good

  3. Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA

    J C Bohnhoff, S A DiSilvio, R K Aneja, Y A Domnina, B S Brozanski & M Good

  4. Division of Pediatric Critical Care Medicine, Departments of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA,

    R K Aneja & Y A Domnina

  5. Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA,

    J R Shenk

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  1. J C Bohnhoff
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Correspondence to M Good.

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Bohnhoff, J., DiSilvio, S., Aneja, R. et al. Treatment and follow-up of venous thrombosis in the neonatal intensive care unit: a retrospective study. J Perinatol 37, 306–310 (2017). https://doi.org/10.1038/jp.2016.218

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