Clinical outcome of umbilical artery catheter-related thrombosis—a cohort study

Abstract

Objective: To reveal the incidence of umbilical artery catheter-related thrombosis (UACRT), the associated risk factors and the natural history of clot formation and regression.Study Design: A prospective cohort study. An umbilical artery catheter was inserted in 61 infants, who were evaluated and followed by serial duplex ultrasound studies for the development of UACRT, renal artery resistance index (RI) and clot resolution. Maternal and infant clinical variables were correlated with the characteristics of thrombi.Result: Nineteen infants developed UACRT, all resolved spontaneously without sequella; most had maximal length at the first evaluation. No correlation was found between the thrombus length and time to resolution. The RI did not differ between the infants with and without UACRT. After adjusting for possible confounding, catheter days was the only covariate associated with UACRT.Conclusion: Asymptomatic UACRT in our cohort was a self-resolving disease; it was associated with catheter days and did not necessitate medical treatment.

Impact of umbilical catheterization on morbidity and mortality in extremely premature newborns

“…Therefore, it is worrisome that in our attempt to demonstrate improved outcomes from umbilical vessel catheterization, we found that death was independently associated with UVC placementeven after adjusting for confounding variables such as birth weight, gestational age, and secondary morbid outcomes. Some investigators have questioned the advisability of UAC placement because of demonstrated thrombi in the aorta at autopsy or risks of bowel ischemia during enteral nutrition [5][6][7], but less has been published about the risks of UVC placement.…”

Renal vascular thrombosis in the newborn

“…Retrospective and prospective data are mostly from catheter-related RAT, and the reported incidence varies according to the method used to diagnose the event. The reported incidence based on clinical signs ranges from 1 to 3 %, that based on ultrasound (US)-based studies varies from 14 to 35 % and the highest incidence of RAT has been reported in ion angiographic investigations at 64 % [11,12]. With the increased use of central catheters for invasive therapeutic interventions, especially umbilical venous and umbilical artery catheters (UACs), as well as femoral catheters, the incidence of renal vascular thrombosis is expected to be much higher.…”

“…On the other hand, diagnosis of spontaneous RAT in the newborn is often suspected based on the presence of risk factors, as many infants only present with transient hypertension [12,18]. Acute renal insufficiency is rare, unless there is extension of thrombus in the aorta to occlude both renal arteries.…”

“…Ideally, the UAC should not be left in place for >5 days. Some studies favor conservative treatment and the avoidance of antithrombotic and/or thrombolytic medications for asymptomatic UAC-related thrombus [12,20]. For neonates and children with a symptomatic peripheral arterial catheter-related thromboembolism, in particular femoral artery catheter thrombosis, UFH anticoagulation with or without thrombolysis or surgical thrombectomy and microvascular repair with subsequent heparin therapy is recommended [23].…”

Neonatal Hemostatic Disorders: Issues and Challenges

“…Umbilical artery CRT (UACRT) is usually asymptomatic and related to the duration of the catheter placement. 19 Shortterm complications include lower extremity ischemia, congestive heart failure, impaired renal function, and hypertension. Necrotizing enterocolitis has been reported as an embolic complication.…”