Central Venous Line Thrombosis in Premature Infants: A Case Management and Literature Review

Abstract

Increased risk of central venous line thrombosis in tiny premature infants occurs because the size of the catheter relative to the cross-sectional area of the vessel is large, decreased plasma levels of plasminogen and antithrombin III, and relative low flow of the infusate through the catheter, in comparison with larger infants. A potentially fatal complication of central venous catheters is an intracardiac thrombus. The yield of detecting right atrial thrombi by routine echocardiographic monitoring is very low. Persistent positive blood cultures in infants with central venous lines, in spite of appropriate antibiotic therapy, or signs of catheter occlusion, may increase the yield of echocardiographic detection of intracardiac thrombi. Surgical removal of intracardiac thrombi in infants weighing less than 1500 gm carries a high mortality rate because of the need to use cardiopulmonary bypass with total circulatory arrest and profound hypothermia during surgery. It is in these infants that thrombolysis with urokinase should be considered. A successful therapy with urokinase of a complete occlusion of the right pulmonary artery by an embolus originating from the right atrium is described in a premature infant. For thrombolysis, a loading dose of urokinase of 4400 U/kg followed by 4400 to 8800 U/kg/hr for a few days was used. The thrombolytic effect was manifested by decreased thrombus echogenicity followed by its disappearance, by increased fibrinogen split products, and by decreased plasma fibrinogen. Urokinase therapy may cause massive bleeding, dislodge an intracardiac thrombus causing obstruction of cardiac valves or main vessels or causing embolization to the pulmonary or systemic circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracardiac Thrombus in Children: The Fine Equilibrium Between the Risk and the Benefit

“…Hereditary or acquired risk factors, such as prematurity, cyanosis, bacteremia, malignancy, nephrotic syndrome, indwelling (umblical or central venous) catheters and acquired or genetic thrombophilia (protein C/S deficiency, factor V Leiden or prothrombin gene mutations) have been clearly defined as the most common etiologies to date [1,2,3]. However, treatment of these cases has some controversies because of the potential complications, such as hemorrhage and embolization.…”

The preterm infant with thrombosis

“…CVL placement is one of the most important risk factors for thrombosis in the neonatal period 1–3 13–20. The increased risk of catheter-related thrombosis in this population is likely due to large catheter size relative to the vessel diameter, vessel wall damage, infusion of high osmolar solutions in total parenteral solutions and low flow of the infusate through the vessel.…”

Vascular Thrombosis in Newborn Infants

“…5 In addition, severe transient deficiencies of antithrombin III, protein C and protein S in sick newborn infants increase the risk of vascular thrombosis. 6,7 Neonatal thrombosis is a serious event that can cause mortality or result in severe morbidity and disability. 8 Umbilical catheterization is identified as a risk factor of vascular thrombosis in neonates.…”