Venous thromboembolism in childhood: A prospective two-year registry in The Netherlands

Objective: To study the incidence, signs and symptoms, diagnostic tests, ri sk factors, therapy, and complications of pediatric venous thromboembolism (VTE) in The Netherlands. Methods: A prospective 2-year registry of VTE in children aged less than or equal to 18 years. Results: Ninety-nine patients were registered. The annual incidence of VTE was 0.14/10,000 children, 35% of whom were symptom free. Almost half of the patients were newborns. Neonatal VTE was almost exclusively catheter relat ed, located in the upper venous system, and asymptomatic. In older children VTE was catheter related in approximately one third and more often was loc ated in the lower venous system. In 85% of all patients, thrombosis develop ed while the patient was in the hospital. Diagnosis was usually made by ult rasonography. In 98% of all patients, at least 1 risk factor was present. C ongenital prothrombotic disorders were more often present in older children (21%) than in neonates (6%). A variety of treatment modalities were used. Morbidity consisted of bleeding (7%) and recurrent thrombosis (7%). Two chi ldren died as result of VTE. Conclusion: VTE is mostly diagnosed in hospitalized children, especially si ck newborns with central venous catheters and older children with a combina tion of risk factors. Primary prevention, optimal treatment, and long-term outcome of pediatric symptomatic and asymptomatic VTE need to be studied.