An international survey on current practices of management of neonatal catheter-associated venous thromboembolism: communication from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis

Abstract

Background The International Society on Thrombosis and Haemostasis Scientific and Standardization Committee on Pediatric/Neonatal Thrombosis and Haemostasis formed a multidisciplinary working group to assess current practices in the management of neonatal thrombosis, focusing on catheter-associated venous thromboembolism (CA-VTE) and to identify gaps in care. Objectives To determine which clinicians manage neonatal thrombosis and to characterize diagnostic and treatment approaches for neonatal CA-VTE. Methods An international cross-sectional survey was conducted using REDCap (version 14.5.7) from October 1, 2024 to December 31, 2024, following institutional review board approval. The survey was distributed through international professional societies to clinicians involved in neonatal thrombosis care. Neonates were defined as term and preterm infants from birth up to 44 weeks corrected gestational age. Descriptive statistics summarized demographics and responses to multiple-choice and Likert scale-type questions. Results A total of 135 clinicians participated, primarily neonatologists ( n = 59, 43.7%) and pediatric hematologists ( n = 55, 39.3%). Most had over 10 years of clinical experience ( n = 90, 66.7%). Neonatal thrombosis was primarily managed in level III/IV neonatal intensive care units with <5 cases per year ( n = 43, 31.9%). Treatment decisions were influenced by degree of occlusion ( n = 107, 79%), symptoms ( n = 105, 77.8%), thrombus location ( n = 96, 71.1%), and bleeding risk ( n = 98, 72.6%). Heparins were the most common anticoagulants used in both acute (93.3%) and subacute (82.8%) phases. Treatment duration varied widely, from <4 to >12 weeks. Management (expectant vs anticoagulation) depended on thrombus characteristics. Conclusion Our findings underscore significant variability in the management of neonatal CA-VTE and highlight opportunities for standardization. Enhanced awareness and international collaboration are essential to improving outcomes for this vulnerable population.