Risk Factors for Umbilical Venous Catheter-Associated Thrombosis in Very Low Birth Weight Infants.

Abstract

Background: Thrombosis in neonates is a rare but serious occurrence that is usually associated with central catheterization. Among acquired risk factors, thrombocytosis has often been thought to play a role in neonatal thrombosis, but little evidence exists to support this impression. Objectives:To investigate the effects of platelet count on catheter-related thrombosis in neonates.To investigate the effects of being small for gestational age (SGA) on catheter-related thrombosis in neonates. We hypothesized that neonates with catheter-related thrombosis would have relative thrombocytosis and would be SGA. Methods: The present retrospective study was performed using data from a randomized trial of duration of umbilical venous catheters (UVC) placement among infants <1250 g birth weight (Butler-O’Hara, Pediatrics2006;118:e25–e35). In this study, all subjects had UVC that were left in place for up to 28 days. All subjects were screened biweekly for thrombi with echocardiograms. Twenty-two cases of UVC-associated thrombosis were identified in this sample. The remaining study sample (n=188) served as controls. Data on thrombosis, platelets, gestational age, birth weight, hematocrit, serum sodium (as a measure of dehydration), duration of catheter placement, study group assignment and demographic factors were collected using database and record review. Results: Among the total subjects (n=210), 112 (53%) were males and 126 (60%) were Caucasians, with mean gestational age of 27.7 ± 2.1 wks (SD) and mean birth weight of 923 ± 195g. Bivariate analysis revealed significant association of thrombosis with hematocrit >55% in the first wk (OR, 5.4; 95% CI, 2.0–14.6; p=0.0003), being small for gestational age (OR, 2.9; 95% CI, 1.2–7.4; p=0.02), lower platelet counts in the first wk (193 ± 57 x 103/uL in infants with thrombus vs. 238 ± 70 x 103/uL in infants without thrombus, p=0.005) and gestational age (27.8 ± 2.5 wks in infants with thrombus vs. 27.6 ± 2.0 wks in infants without thrombus, p=0.02). In multivariate logistic regression analysis, only higher hematocrit was independently associated with thrombus (OR, 3.9; 95% CI 1.3–12.6; p=0.02). There was a trend towards an independent negative association between platelets and thrombosis (OR, 0.93 per 10 x 103/uL platelet rise; 95% CI, 0.85–1.02; p=0.12). Conclusion: This study demonstrates a significant, independent association of elevated hematocrit and development of UVC-associated thrombosis. We did not observe an increased risk of thrombosis with increased platelet count. Careful monitoring for catheter-associated thrombosis is suggested for neonates with hematocrit >55% in the first wk of life.

A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore

“…Risk factors for neonatal venous thrombosis include extreme prematurity (gestational age ≤ 27.7 weeks), extremely low birth weight (birth weight < 900 g), raised haematocrit levels above 55%, and increased duration of indwelling central venous catheters and malpositioned UVCs. (4,23) In one prospective cohort study, necrotising enterocolitis was associated with unrecognised withdrawal of UVC into the portal vein or ductus venosus, (24) while a case of intestinal perforation secondary to UVC passing through an anomalous patent vitellointestinal duct has also been reported. (25) These two studies demonstrate that the compromise of vascular supply in malpositioned UVCs, with or without thrombosis, may cause gastrointestinal perforations.…”

Nabelvenenkatheter in der neonatologischen Intensivbehandlung – Teil 2

“…Diese werden mit einer sehr unterschiedlichen Häufigkeit je nach betrachtetem Kollektiv angegeben [18,23,24]. In einer retrospektiven Studie an 210 Frühgeborenen mit einem Geburtsgewicht < 1250 g betrug die Rate an Pfortaderthrombosen 10 % und in einer weiteren Analyse an 109 Früh-und Reifgeborenen sogar 43 % [25]. Hauptrisikofaktoren sind ▪ die NVK-Malposition, d. h. eine zu kaudale und nicht-zentrale Katheterposition, ▪ eine ungewöhnlich lange Katheterliegezeit und ▪ die Infusion von Blutprodukten [17,18,26].…”

“…Es besteht ein signifikanter Zusammenhang zwischen NVK-assoziierten Thrombosen und einem Hämatokritwert > 55 % [25].…”

Nabelvenenkatheter in der neonatologischen Notfall- und Intensivbehandlung

“…Es besteht ein signifikanter Zusammenhang zwischen NVK-assoziierten Thrombosen und einem Hämatokritwert > 55 % [30].…”