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Newborns are the most vulnerable patients for thrombosis development among all children, with critically ill and premature infants being in the highest risk group. The upward trend in the rate of neonatal thrombosis could be attributed to progress in the treatment of severe neonatal conditions and the increased survival in premature babies. There are physiological differences in the hemostatic system between neonates and adults. Neonates differ in concentrations and rate of synthesis of most coagulation factors, turnover rates, the ability to regulate thrombin and plasmin, and in greater variability compared to adults. Natural inhibitors of coagulation (protein C, protein S, antithrombin, heparin cofactor II) and vitamin K-dependent coagulation factors (factors II, VII, IX, X) are low, but factor VIII and von Willebrand factor are elevated. Newborns have decreased fibrinolytic activity. In the healthy neonate, the balance is maintained but appears more easily converted into thrombosis. Neonatal hemostasis has less buffer capacity, and almost 95% of thrombosis is provoked. Different triggering risk factors are responsible for thrombosis in neonates, but the most important risk factors for thrombosis are central catheters, fluid fluctuations, liver dysfunction, and septic and inflammatory conditions. Low-molecular-weight heparins are the agents of choice for anticoagulation. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic substantially impacted different age groups, with children and young people not exempted. Many have experienced enduring health consequences. Presently, there is no consensus on the health outcomes to assess in children and young people with post-COVID-19 condition. Furthermore, it is unclear which measurement instruments are appropriate for use in research and clinical management of children and young people with post-COVID-19. To address these unmet needs, we conducted a consensus study, aiming to develop a core outcome set (COS) and an associated core outcome measurement set (COMS) for evaluating post-COVID-19 condition in children and young people. Our methodology comprised of two phases. In phase 1 (to create a COS), we performed an extensive literature review and categorisation of outcomes, and prioritised those outcomes in a two-round online modified Delphi process followed by a consensus meeting. In phase 2 (to create the COMS), we performed another modified Delphi consensus process to evaluate measurement instruments for previously defined core outcomes from phase 1, followed by an online consensus workshop to finalise recommendations regarding the most appropriate instruments for each core outcome. In phase 1, 214 participants from 37 countries participated, with 154 (72%) contributing to both Delphi rounds. The subsequent online consensus meeting resulted in a final COS which encompassed seven critical outcomes: fatigue; post-exertion symptoms; work/occupational and study changes; as well as functional changes, symptoms, and conditions relating to cardiovascular, neuro-cognitive, gastrointestinal and physical outcomes. In phase 2, 11 international experts were involved in a modified Delphi process, selecting measurement instruments for a subsequent online consensus workshop where 30 voting participants discussed and independently scored the selected instruments. As a result of this consensus process, four instruments met a priori consensus criteria for inclusion: PedsQL multidimensional fatigue scale for "fatigue"; PedsQL gastrointestinal symptom scales for "gastrointestinal"; PedsQL cognitive functioning scale for "neurocognitive" and EQ-5D for "physical functioning". Despite proposing outcome measurement instruments for the remaining three core outcomes ("cardiovascular", "post-exertional malaise", "work/occupational and study changes"), a consensus was not achieved. Our international, consensus-based initiative presents a robust framework for evaluating post-COVID-19 condition in children and young people in research and clinical practice via a rigorously defined COS and associated COMS. It will aid in the uniform measurement and reporting of relevant health outcomes worldwide., Competing Interests: Conflict of interest: D. Munblit is a Co-Chair of International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Global Paediatric Long COVID Working Group, member of ISARIC working group on long-term follow-up in adults. C. Apfelbacher reports grants or contracts from Dr Wolff Group, Bionorica and The European Cooperation in Science and Technology (COST); he also acknowledges consulting fees from the Dr Wolff Group, Bionorica, Sanofi and LEO Pharma; he serves as a Co-Chair Harmonising Outcome Measures for Eczema (HOME) initiative and is Co-Chair of the Hand Eczema Core Outcome Set (HECOS) initiative and is core principal investigator of the KUNOKids Health Study (Regensburg, Germany). J.V. Diaz is the lead of the clinical management response pillar for COVID-19 and in that capacity convenes the WHO Clinical Characterization and Management Research working group; the Post COVID-19 COS steering committee was a sub-working group of this bigger group. O.L. Aiyegbusi has received research grants from UCB, Kidney Research UK, Gilead Sciences Ltd, The Health Foundation, NIHR Birmingham BRC, NIHR ARC, NIHR BTRU, Innovate UK, Merck, GSK, Anthony Nolan and Sarcoma UK; he has also received personal fees from GSK, Gilead Sciences, Innovate UK and Merck. C.R. Oliveira receives grant support from the National Institutes of Health (NIH), grant numbers OT2HL161847 and K23AI159518. P.R. Williamson is chair of the Core Outcome Measures in Effectiveness Trials (COMET) Management Group. Other authors declare that they have no competing interests., (Copyright ©The authors 2024.)