More than a baby step toward improved treatment: Commentary on “NEOnatal Central-venous Line Observational study on Thrombosis (NEOCLOT): evaluation of a national guideline on management of neonatal catheter-related venous thrombosis”

Neonates who are ill are at a relatively high risk of developing thrombosis, particularly with the placement of a central venous catheter (CVC) [ [1] O’Brien S.H. Stanek J.R. Witmer C.M. Raffini L. The continued rise of venous thromboembolism across US Children’s Hospitals. Pediatrics. 2022; 149e2021054649 PubMed Google Scholar , [2] Bhat R. Kumar R. Kwon S. Murthy K. Liem R.I. Risk factors for neonatal venous and arterial thromboembolism in the neonatal intensive care unit–a case control study. J Pediatr. 2018; 195: 28-32 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ]. Because the presence of a CVC is the single most common risk factor for thrombosis in neonates, data regarding optimal management are crucial. Studies evaluating the treatment of neonates for catheter-related venous thromboembolism (CVTE) are limited. These studies are difficult to perform because of the variations in practice, the rare nature of pediatric thrombosis, and a lack of consistent data collection across institutions. Many of the published studies reflect experience at a single center. A previous systematic review published by Park et al. [ [3] Park C.K. Bosco A.P. Nagel K. Chan A.K. Murthy P. Thrombosis and Hemostasis in Newborns (THiN) Group. Neonatal central venous catheter thrombosis: diagnosis, management and outcome. Blood Coagul Fibrinolysis. 2014; 25: 97-106 Crossref PubMed Scopus (63) Google Scholar ] attempted to establish an evidence-based guideline for the diagnosis, management, and treatment of CVC-related thrombosis in neonates through a systematic review of published studies. The incidence of thrombosis identified was 9.2% (308/3332) over the whole population with umbilical catheters and peripherally inserted central catheters accounting for 80% of venous thromboembolism (VTE). Treatment modalities ranged from thrombolysis to watchful waiting and were disparate across the examined studies. Standard anticoagulant therapies, such as low-molecular weight heparin, were not discussed. Although this publication was very helpful to practice, it was limited as a systematic review rather than a prospective analysis.