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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Thrombosis in newborns: experience from 31 cases

Abstract

Thrombosis is the result of congenital or acquired prothrombotic risk factors. The incidence of thrombosis in the paediatric population is highest in newborns, as about 10% of thrombotic events occur in the first four weeks of life. Haemostasis in a newborn, though still developing, is a well balanced mechanism. About 90% of all thrombotic events are due to acquired and the rest to congenital risk factors.
The aim of our study was to estimate the incidence of thrombosis in a population of Slovenian newborns and to study risk factors, location and treatment of thrombotic events.
Inpatient charts of newborns with thrombosis, admitted to a tertiary neonatology centre and paediatric intensive care unit between 2004 and 2011, were studied retrospectively. Family history, location, aetiology and treatment of thrombosis were analysed.
Thirty one newborns, 17 boys (54.8%) and 14 girls (45.2%), with 31 thrombotic events were found. There were 17 cases (54.8%) of arterial and 14 cases (45.2%) of venous thrombosis. A  family history of thrombophilia was found in two cases (6.5%). Twenty six cases (83.9%) were contributed to acquired risk factors and five (16.1%) to congenital aetiology. Four cases (12.8%) were treated, two with anticoagulation, one with thrombolysis and one with both. The estimated incidence of thrombosis was 0.17 per 1000 live births. Our data showed a higher incidence of thrombosis in Slovenian newborns and a higher incidence of congenital prothrombotic risk factors than in the data published so far.

 

Key words: newborn, thrombosis, incidence, risk factor, treatment

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Near-death experiences and electrocardiogram patterns in out-of-hospital cardiac arrest survivors: a prospective observational study

Abstract

Aim. To determine the effect of several factors, that are a part of cardiac arrest and resuscitation, on the incidence of near-death experiences (NDEs).
Methods. We conducted a prospective observational study in the three largest hospitals in Slovenia in a consecutive sample of patients after out-of-hospital primary cardiac arrest. The presence of NDE was assessed with the  self-administered Greyson’s near-death experiences scale. The electrocardiogram pattern at the beginning of  resuscitation was recorded. Main outcome measure was the presence of near-death experiences. Univariate analysis was used.
Results. The study included 52 patients. There were 42 (80.8%) males in the sample; median age ± standard deviation of the patients was 53.1 ± 14.5 years. Near-death experiences were reported by 11 (21.2%) patients. Patients with ventricular fibrillation had significantly less NDEs than other patients (12.2% vs. 54.5%, P = 0.006). Patients with pulseless electrical activity had significantly more NDEs than others (60.0% vs. 11.9%, P = 0.003). Patients with asystole  and pulseless electrical fibrillation had significantly more NDEs than patients who had ventricular fibrillation and ventricular tachycardia (60.0% vs. 11.9%, P = 0.003). Patients with at least one defibrillation attempt had significantly less near-death experiences than others (62.5% vs. 13.6%, P = 0.007).
Conclusion. Our study found a possible correlation between electrocardiogram pattern in cardiac arrest patients and the incidence of near-death experiences. Further studies should address this problem in larger  samples.

Key words: near-death experiences, electrocardiogram, heart arrest, incidence, prospective study, resuscitation

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