DEEP VENOUS THROMBOSIS
Deep venous thrombosis (DVT) and pulmonary embolism are common, potentially life-threatening complications in SCI. Although DVT is somewhat less common in prepubertal children, it still does occur.
The most common time of occurrence is during the first few weeks after the SCI. Recommendations for prophylaxis against DVT in pubertal children include low-dose heparin or low-molecular-weight heparin and calf compression pumps during the rehabilitation hospitalization. Late-occurring DVT most commonly occurs with increased immobilization related to illness or surgery.Symptoms of DVT include a swollen, warm extremity, with or without fever. If the child has sensation, this may be accompanied by pain. Differential diagnoses include cellulitis, fracture, reflex sympathetic dystrophy, and heterotopic ossification. Diagnosis is confirmed by Doppler ultrasound. If the ultrasound is negative and the index of suspicion for DVT is high, a venogram or MR imaging may be necessary. Plain radiographs should be obtained, especially in prepubertal children and in those whose SCI occurred more than three months previously to rule out fractures. Once a DVT is confirmed, treatment is bed rest until adequate heparinization is achieved to maintain the partial thromboplastin time 1.5 to 2.5 times control values. Treatment should continue for three to six months. Complications of heparin and warfarin include bleeding for both and heparin-induced thrombocytopenia. Warfarin may interact with many medications, and the patient and family should be fully educated about this if warfarin is to be continued after hospital discharge.
Temperature regulation
Children with SCI above T6 frequently have problems with temperature regulation because of the loss of central control of sympathetic and voluntary muscles (36). They must thus dress according to the environmental temperature. Before investigating the source of hyperthermia or hypothermia, investigation should be made into the temperature of the environment where the child has been. Often, undressing the child or putting a blanket over the child is all that is necessary to treat the hyperthermia or hypothermia. For children who reside in areas with cold weather, the use of a Mylar space blanket to maintain body heat is recommended for emergency situations. Baclofen withdrawal with resultant severe spasticity may cause extreme hyperthermia (37).