Bilateral acute femoral head epiphyseal separation following hip compartment syndrome in neonatal post-vaccine immune thrombocytopenia: a systematic review and pathophysiological hypothesis
DOI:
https://doi.org/10.70577/b8fnw754Keywords:
immune thrombocytopenia; vaccination; compartment syndrome; epiphysiolysis; neonatal hip; hemorrhagic complicationsAbstract
Introduction: Post-vaccine immune thrombocytopenia (ITP) in neonates is a recognized but infrequent entity (Ronchi et al., 1998). Its association with severe hemorrhagic complications, such as hip compartment syndrome and subsequent femoral epiphyseal separation, has not been described in the indexed literature. Objective: To systematically review the available evidence on each link of this possible causal chain and to propose a pathophysiological hypothesis explaining their interrelation. Methods: Exploratory systematic review following PRISMA 2020 guidelines (Page et al., 2021). A systematic search was conducted in PubMed/MEDLINE, Europe PMC, and Scopus (January 1980 to October 2026). Case reports, case series, and reviews on neonatal post-vaccine ITP, pediatric compartment syndrome, and neonatal proximal femoral epiphysiolysis were included. Methodological quality was assessed using the JBI tool. Results: Forty-seven records were identified, of which 12 were assessed at full text and 8 met eligibility criteria. Cases of ITP after hepatitis B vaccination in infants were documented (Ronchi et al., 1998), as were classic series of neonatal proximal femoral epiphysiolysis with conservative management and favorable outcomes (Ogden et al., 1984), and cases of compartment syndrome in children secondary to skin traction or femoral cannulation (Janzing et al., 1996; Selby & Doyle, 1995). Proposed hypothesis: It is postulated that post-vaccine ITP could trigger intra-articular or intramuscular bleeding in the neonatal hip, raising intracompartmental pressure and compromising epiphyseal vascularization. The resulting ischemia could weaken the physis and predispose to acute bilateral epiphyseal slip or separation. Conclusions: The proposed causal chain is pathophysiologically plausible but unproven. Publication of detailed clinical cases and prospective studies are required to validate or refute this hypothesis.
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Copyright (c) 2026 Marlon Alejandro Toro Calderon, Arianna Guadalupe Andrade Cordova, Micaela Lucia Sanaguano Moreno, Francis Adalberto Palacios Halaby, Jenny Mireya Pacheco Cahueñas (Autor/a)
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