EFFICACY AND SAFETY OF HEPARIN ANTICOAGULATION FOR NEONATAL RENAL-VEIN THROMBOSIS

Purpose: We report on the safety and efficacy of heparin anticoagulati on for the treatment of neonatal renal vein thrombosis. Patients and M ethods: Six consecutive, prospectively identified, critically ill neon ates with renal vein thrombosis were studied. Diagnosis of renal vein thrombosis was based on history and examination and confirmed with ren al ultrasound. All neonates were treated with continuous i.v. heparin titrated to achieve a therapeutic whole blood clotting time and/or APT T. Results: Renal vein thrombosis was bilateral for three of six neona tes. Heparin infusion rates varied from 8 to 40 U/kg/h and were admini stered for 7-14 days. Two neonates developed hemorrhagic complications ; one had disseminated intravascular coagulation but did not hemorrhag e until heparin toxicity ensued, and another was well until an umbilic al catheter was removed while he was therapeutically heparinized. Rena l outcome at 3 months to 6 years showed hypertension in one neonate, a trophic kidneys in two, and both hypertension and an atrophic kidney i n one. Conclusions: Bleeding was a significant complication of heparin therapy for neonatal renal vein thrombosis. Renal dysfunction was not prevented in four of six neonates treated with heparin. Alternative a pproaches to titrate heparin, alternative anticoagulants, or fibrinoly tic therapy should be considered as therapy for neonatal renal vein th rombosis.