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Abstract(s)
A trombose venosa (TV) neonatal é uma condição rara, com escassos estudos documentados na literatura. No entanto, devido ao maior reconhecimento clínico, à utilização de técnicas imagiológicas mais sofisticadas e à melhoria dos cuidados de saúde neonatais, a sua incidência aumentou consideravelmente nas últimas duas décadas. Desta forma, torna-se imperativo um avanço proporcional na qualidade da abordagem terapêutica da TV neste grupo específico. Contudo, as particularidades fisiológicas de um sistema hemostático recém-formado limitam a tão ampla e comum extrapolação de dados de estudos de adultos para a população pediátrica. Em Portugal, com base na melhor experiência profissional, o tratamento tem sido limitado principalmente à heparina de baixo peso molecular e à heparina não fracionada. Porém, devido às numerosas limitações que os anticoagulantes tradicionais apresentam, os anticoagulantes orais diretos emergiram como uma opção terapêutica promissora, oferecendo vantagens na administração e monitorização. Todavia, a sua eficácia e segurança continuam a representar um desafio em neonatologia, devido à sua subrepresentação nos vários ensaios clínicos. De forma a ilustrar os desafios das abordagens terapêuticas atuais e futuras da TV neonatal, neste trabalho é apresentado um caso clínico de um recém-nascido com uma malformação uronefrológica complicada com insuficiência renal severa, urosépsis a Enterococcus faecalis e trombose assintomática da veia porta esquerda.
Neonatal venous thrombosis (VT) is a rare condition, with few documented studies in the literature. However, due to increased clinical recognition, the use of more sophisticated imaging techniques, and improvements in neonatal healthcare, its incidence has significantly increased over the past two decades. Therefore, a proportional advancement in the quality of the therapeutic approach to VT is imperative in this specific group. However, the physiological particularities of a newly formed hemostatic system limit the broad and common extrapolation of data from adult studies to the pediatric population. In Portugal, based on the best professional experience, treatment has mainly been limited to low molecular weight heparin and unfractionated heparin. However, due to the numerous limitations of traditional anticoagulants, direct oral anticoagulants have emerged as a promising therapeutic option, offering advantages in administration and monitoring. Nevertheless, their efficacy and safety continue to pose a challenge in neonatology, due to their underrepresentation in various clinical trials. To illustrate the challenges of current and future therapeutic approaches to neonatal VT, this work presents a clinical case of a newborn with a complicated uronephrological malformation with severe renal insufficiency, Enterococcus faecalis urosepsis, and asymptomatic left portal vein thrombosis.
Neonatal venous thrombosis (VT) is a rare condition, with few documented studies in the literature. However, due to increased clinical recognition, the use of more sophisticated imaging techniques, and improvements in neonatal healthcare, its incidence has significantly increased over the past two decades. Therefore, a proportional advancement in the quality of the therapeutic approach to VT is imperative in this specific group. However, the physiological particularities of a newly formed hemostatic system limit the broad and common extrapolation of data from adult studies to the pediatric population. In Portugal, based on the best professional experience, treatment has mainly been limited to low molecular weight heparin and unfractionated heparin. However, due to the numerous limitations of traditional anticoagulants, direct oral anticoagulants have emerged as a promising therapeutic option, offering advantages in administration and monitoring. Nevertheless, their efficacy and safety continue to pose a challenge in neonatology, due to their underrepresentation in various clinical trials. To illustrate the challenges of current and future therapeutic approaches to neonatal VT, this work presents a clinical case of a newborn with a complicated uronephrological malformation with severe renal insufficiency, Enterococcus faecalis urosepsis, and asymptomatic left portal vein thrombosis.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Keywords
Trombose venosa Neonatal Anticoagulação Tratamento Resultado Pediatria