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Semin Thromb Hemost 2018; 44(07): 617-623
DOI: 10.1055/s-0038-1660852
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hemostasis in the Very Young

Gili Kenet
1   National Hemophilia Center, Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, Tel-Hashomer, Israel
2   Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
,
Assaf Arie Barg
1   National Hemophilia Center, Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, Tel-Hashomer, Israel
2   Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
,
Ulrike Nowak-Göttl
3   Thrombosis and Hemostasis Treatment Center, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Campus Kiel and Lubbeck, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 June 2018 (online)

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Abstract

Hemostasis is a dynamic process that starts in utero. The coagulation system evolves with age, as evidenced by marked physiological differences in the concentration of the majority of hemostatic proteins in early life compared with adulthood. This concept, known as “developmental hemostasis,” has important biological and clinical implications. Overall, impaired platelet function, along with physiologically reduced levels of vitamin K–dependent and contact coagulation factors, may cause poorer clot firmness even in healthy neonates. However, increased activity of von Willebrand factor and low levels of coagulation inhibitors that promote hemostasis counterbalance the delicate and immature hemostatic system. Since this hemostatic system has little reserve capacity, preterm neonates or sick infants are extremely vulnerable and predisposed to either hemorrhagic or thrombotic complications. This review will address the concept and manifestations of developmental hemostasis with respect to clinical disease phenotypes. It will discuss bleeding diagnosis in neonates, dealing especially with the devastating complications of intracerebral and pulmonary hemorrhage in preterm infants. Neonates, especially the sickest preterm ones, are also extremely susceptible to thrombotic complications; thus, thrombosis in neonates will be reviewed, with special focus on arterial ischemic perinatal stroke. Based on the concept of developmental hemostasis, the phenotypes of clinically relevant bleeding or thrombotic disorders among neonates may differ from those of older infants and children. Treatment options for these conditions will be suggested and reviewed.

Keywords

neonates - developmental hemostasis - thrombosis - anticoagulant
 

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