Clinical characteristics, anticoagulation therapy, and short-term outcomes of neonatal cerebral sinovenous thrombosis: a cross-sectional study from a Chilean center

Abstract

Abstract Purpose: Cerebral sinovenous thrombosis (SVT) is a rare but severe condition, with neonates having the highest incidence among pediatric patients. The underlying conditions contributing to SVT are heterogeneous, and although anticoagulation therapy (ACT) is safe and potentially beneficial, the evidence supporting its effectiveness on neurological outcomes is lacking. This study analyzed the association of clinical-demographic characteristics and ACT in the acute setting with vital-neurological outcomes at discharge in neonates with SVT. Methodology: This cross-sectional study utilized secondary data from 30 neonates with SVT confirmed by MRI/MRV at a single center in Chile between 2005 and 2021. Penalized maximum likelihood logistic regression models were conducted to calculate adjusted odds ratios. Results: The median gestational age, weight, and age of diagnostic were 38 weeks (IQR 37–39), 3141 grams (IQR 2579–3478), and 15 days (IQR 8.7–27.5), respectively. All patients had diffuse neurological signs. Acute seizures and focal deficits were detected in 12 (40%) and 1 (3.3%) cases. At discharge, 15 (50%) patients had a neurological deficit, and 7 (23.3%) died. The frequency of ACT use was higher between 2013 and 2021 than between 2005 and 2012 (8% vs. 2%, Fisher's exact test, p 0.05). Adjusted for demographic and clinical variables, ACT was negatively associated with adverse vital or neurological outcomes (OR 0.18, 95% CI 0.03–1.00). Conclusions: ACT increased its use over time. Our results suggest that ACT in neonates with SVT is associated with better neurological outcomes at discharge and lower in-hospital case fatality. Further follow-up is needed to establish long-term associations.