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Neonatal spontaneous arterial thromboembolism is a rare phenomenon with a high risk of morbidity and mortality. Currently, there is little information regarding common risk factors, diagnostic strategies, therapeutic interventions, and outcomes of this condition. The objective was to nucleate the best evidence regarding the disorder in order to facilitate early detection and treatment recommendations and document adverse outcomes. Web of Science, PubMed, Medline, CINAHL, Cochrane Databases, DARE, and OVID databases were searched using the following keywords: 'arterial' AND 'thrombus' OR 'thrombosis' OR 'thromboembolism' OR 'embolism' AND 'spontaneous' AND 'at birth' OR 'newborn' OR 'neonatal' OR 'fetal' AND 'umbilical cord' OR 'umbilical wall necrosis' AND 'coagulation abnormality' OR 'placenta bits' OR 'ischemic limbs'. The search yielded 172 articles, all of which were case series or single case descriptions. Twenty-seven met inclusion criteria, with a total of 53 newborns and 30 newborn pathology reports. Ultrasound was the preferred method of diagnosis and thromboembolic locations varied with the most common site being umbilical, resulting in embolism and vascular compromise. Treatment interventions and drug dosages were not standardized and ranged from use of anticoagulants to surgery and hyperbaric oxygen. The reported mortality rate was 32.8%. Recurring etiological features facilitated identification of possible sequences of events contributing to the disorder. The literature lacks empirical evidence to affirm causes and predisposing risk factors for timely diagnosis and effective treatment of spontaneous neonatal arterial thromboembolism. Further research is needed to clearly establish the causes and the efficacy of specific treatment options.

Background: Thromboembolism (TE) and infection are two common complications of central venous line (CVL). Thrombotic CVL-dysfunction is a common, yet less studied, complication of CVL. Two retrospective studies have reported significant association of CVL-dysfunction and TE. Recent studies indicate association of CVL-related small clot with infection. Infection is the most common cause of non-cancer related mortality in children with cancer. We and others have shown reduced overall survival (OS) in children with cancer and CVL-dysfunction compared to those without CVL-dysfunction. Despite these observations, to date there are no prospective studies to evaluate the clinical significance of CVL-dysfunction and it's impact on the development of TE, infection, or outcome of children with cancer., Study Design: This is a prospective, analytical cohort study conducted at five tertiary care pediatric oncology centers in Ontario. Children (≤ 18 years of age) with non-central nervous system cancers and CVL will be eligible for the study. Primary outcome measure is symptomatic TE and secondary outcomes are infection, recurrence of cancer and death due to any cause. Data will be analyzed using regression analyses., Discussion: The overall objective is to delineate the relationship between CVL-dysfunction, infection and TE. The primary aim is to evaluate the role of CVL-dysfunction as a predictor of symptomatic TE in children with cancer. We hypothesize that children with CVL-dysfunction have activation of the coagulation system resulting in an increased risk of symptomatic TE. The secondary aims are to study the impact of CVL-dysfunction on the rate of infection and the survival [OS and event free survival (EFS)] of children with cancer. We postulate that patients with CVL-dysfunction have an occult CVL-related clot which acts as a microbial focus with resultant increased risk of infection. Further, CVL-dysfunction by itself or in combination with associated complications may cause therapy delays resulting in adverse outcome.This study will help to identify children at high risk for TE and infection. Based on the study results, we will design randomized controlled trials of prophylactic anticoagulant therapy to reduce the incidence of TE and infection. This in turn will help to improve the outcome in children with cancer.

Purpose: Cancer is a major underlying disease in children with thromboembolism. However, the epidemiology of thrombosis in children with cancer is largely unknown. We undertook the following study to define the epidemiology and to identify the risk factors predisposing children with lymphoma to thrombosis., Patients and Methods: We reviewed the medical records of 75 children (<18 years of age) diagnosed with lymphoma from January 1990-December 2004., Results: Nine of 75 patients (12%, 95% CI; 5.6-21.6%) were diagnosed with a total of 16 thrombotic events. Twelve of 16 (75%) events were venous thrombosis; 11 were related to the central venous line. The prevalence of pulmonary embolism was 2.6%. Nine of 51 (17.6%) patients with mediastinal lymphadenopathy developed thrombosis compared to none of 21 patients without mediastinal lymphadenopathy (Z=3.31, p=0.001, 95%CI; 7.2-28.1%). Older children and children with advanced stage disease were at higher, but statistically non-significant risk of thrombosis. There was no effect of gender, lymphoma type, or B-symptoms on the occurrence of thrombosis. Four of 9 patients (44%) experienced recurrent clots and 3 (33.3%) patients had post-thrombotic syndrome. Children with thrombosis had a higher rate of adverse events compared to those without thrombosis (41% vs. 21.2%, p=0.126)., Conclusion: Thrombosis is a frequent complication in children with lymphoma with over a 40% recurrence rate and significant morbidity. Children with a mediastinal mass were at significantly increased risk of thrombosis. Larger prospective studies are required to confirm these findings and to identify children at an increased risk for the development of thrombosis.