Thrombosis in children, cases are increasing in hospitalized children –

from Vera Martinella

Risk factors in children are difficult to recognize, more complex and less known than in adults. Recognizing the symptoms and immediately intervening with anticoagulation therapy makes the difference

Heart attacks, strokes, emboli are not “childish” pathologies and yet they can also occur in the youngest due to a thrombosis, which, although a very rare occurrence in the pediatric age, arouses great concern among specialists. In fact, for the last 20 years the number of thrombosis cases in hospitalized children increased tenfold, and reached an incidence of one case for every 200 under 18 years admitted. To address this new danger, the Association for the Control of Thrombosis and Cardiovascular Diseases (ALT Onlus) inaugurates the eleventh National Day for the Fight against Thrombosis, planned Wednesday, April 20thprecisely for information and prevention of these problems in children and adolescents.

What is and what causes thrombosis

“Thrombosis is a phenomenon caused by an excessive tendency in the blood to clot – he explains Lidia Rota Vender, President of EVERYTHING -. It can occur in the arteries, causing stroke, myocardial infarction, limb ischemia which can have devastating consequences such as amputation of the affected limb. Or in the superficial or deep veins, causing phlebitis or thrombophlebitis or deep vein thrombosis, which unfortunately very often releases emboli that reach the lung, causing pulmonary embolism ». These events are a fairly rare problem in pediatric age (with an incidence of approximately one case per 100,000 children per year), but in inpatients under the age of 18, on the other hand, the risk of developing venous thrombosis is much higher (one in 200), with a peak with the highest incidence in infants and adolescents. “Knowledge and information are fundamental because thrombotic events in children as well as adults can be avoided immediately with the right lifestyle – emphasizes Rota Vender, specialist in hematology and cardiovascular disease from thrombosis -: diet rich in fruits and vegetables, adequate hydration and constant physical activity; periodic follow-up and regular use of drug treatment when necessary “.

The causes of childhood thrombosis are many

Thrombotic diseases, even in the smallest, diagnosed and treated early generally have a good prognosis: it is necessary to perform quickly anticoagulant therapy which aims to avoid prolongation of thrombosis and to reduce the risk of pulmonary embolism. What can be the triggering causes in children? In the pediatric population, venous thrombosis is always the result of a combination of several risk factors – the expert answers – congenital (genetic mutations affecting coagulation factors) or acquired. The presence of a central venous catheter represents the largest risk factor (90% in the newborn, over 50% in the baby); Prematurity, severe infections or some chronic diseases may contribute to the onset of this pathology. The tendency to develop thrombosis (thrombophilia) can be favored by autoimmune diseases (antiphospholipid antibody syndrome for example), congenital heart disease, tumors and “coagulopathies”, ie diseases characterized by a defect in coagulation factors ». In general, the risk factors in children are less known, difficult to recognize and more complex compared to adults.

Symptoms and diagnosis

In case of a diagnostic suspicion, it is necessary to get confirmed by performing different examinations depending on the district in question: Doppler echo if the symptoms are at the level of a limb (when an arm or leg is suddenly edematous and heavy, it is not advisable to waste time) or of an abdominal organ; magnetic resonance with contrast method or CT angiography if the symptoms are of cerebral nature or at the level of cardiac districts. In all cases, these tests will show the presence of the thrombus and the absence of downstream venous flow. The most common symptoms of cerebral venous thrombosis are: epileptic seizures, change of state of consciousness up to encephalopathy, focal neurological deficits with cranial nerve paresis or hemiparesis and signs of intracranial hypertension such as headache, nausea and vomiting. Seizures are most commonly seen in infants, while focal neurological symptoms, signs of intracranial hypertension, and irritability are more common in older infants and children. Catheter-related thrombosis may present with erythema, pain and edema of the limb where the catheter is located; edema of the neck and face for thrombosis of the superior vena cava; difficulty breathing and arrhythmia in case of atrial thrombosis.

An Italian register to find out more

«The cases of infantile thrombosis in Italy – continues Lidia Rota Vender – have been registered by Italian Register of Infantile Thrombosis (RITI), supported for many years by EVERYONE who believes in the importance of collecting the data collected by doctors and specialists with different backgrounds and education, involved every day in the care and assistance of children suffering from thrombotic pathologies. A register that sees Italy among the first countries in the world to collect and share cases of neonatal and pediatric thrombosis, from 0 to 18 years, on a digital platform. “The goal of the register – he concludes Paolo Simionifull professor of internal medicine at the Department of Medicine-DIMED, University of Padua and president of the GIRTI ODV Association (Italian Group Association for the Registry of Infantile Thrombosis) – must evaluate the clinical relevance of the problem, define the epidemiological characteristics of infantile thrombosispromote Italian research on the subject, improve childcare through the development of dedicated diagnostic and therapeutic protocols and the creation of a network of expert doctors who can become a point of reference “. On the occasion of the day (until Sunday, May 15th) it will be possible to support research on infantile thrombosis by buying the small plush squirrels and rabbits from the limited edition collection that Trudi has decided to dedicate to EVERYTHING: For every purchase made on the online shop, the historical producer will sell 5 euros to the association.

20 April 2022 (change 20 April 2022 | 10.30 am)

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