RESUMEN
Thromboses are infrequent but serious complications of patients in the NICU. Thromboses tend to occur in very sick neonates, particularly preterm neonates, and the majority of such thromboses are related to central vascular catheters. Other risk factors for neonatal thromboses include infants of diabetic mothers, sepsis, small for gestational age, congenital heart disease, maternal antiphospholipid syndrome, and possibly inherited prothrombotic disorders. Appropriate treatment, dosage, and duration of therapy for neonatal thromboses has not been studied in clinical trials. Treatment options include observation, anticoagulation, thrombolysis, and surgical thrombectomy. Regardless of the treatment chosen, all neonates with thromboses require frequent reassessment of the thromboses by angiography, echocardiography, or ultrasound until thrombus resolution occurs.
Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Trombosis/diagnóstico , Trombosis/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Fibrinolíticos/uso terapéutico , Heparina/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Recién Nacido , Factores de Riesgo , Trombosis/etiologíaAsunto(s)
Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/terapia , Hematología/métodos , Neonatología/métodos , Transfusión de Eritrocitos , Eritropoyetina/uso terapéutico , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Granulocitos/trasplante , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Transfusión de Plaquetas , Medicina Preventiva/métodos , Proteínas Recombinantes/uso terapéuticoRESUMEN
The coagulation system differs markedly between fetuses, neonates, and adults, and fetal and neonatal thrombotic abnormalities are poorly understood. Tissue factor pathway inhibitor (TFPI) is an important inhibitor of the extrinsic pathway of coagulation. To begin examining the role of TFPI in the maternal-fetal relationship, TFPI expression in human fetal and placental tissues was studied by immunohistochemical staining. TFPI was widely expressed in human fetal tissues from 8-24 weeks gestation, particularly in epithelial and endothelial tissues. Fetal liver, lung, kidney, and intestine were notably positive for TFPI staining. Within the tissues, TFPI was expressed in pneumocytes, hepatocytes, renal tubular and glomerular cells, muscle fibers, and enterocytes. In placental tissues, TFPI was expressed in syncytiotrophoblasts, cytotrophoblasts, vascular endothelium, and extravillus trophoblasts from 10 weeks through term. Advancing gestation had little effect on TFPI expression. Further studies are needed to determine the functional role of TFPI in fetal and placental tissues and to define perturbations in its expression during fetal and neonatal disease states.