Central Line Related Thrombosis in Neonates: A Population-based Study

Background: The incidence of central line (CVL) related thromboembolism (TE) in neonates is rising dramatically. The mainstay of treatment in neonatal thrombosis is anticoagulant therapy. However, management of neonatal CVL-related TE is particularly complex, as the higher risk of systemic and intracranial bleeding, especially in premature babies, must be balanced with the thrombotic risks including death, or morbidity such as organ dysfunction, post-thrombotic syndrome and neurodevelopmental sequelae. There is a paucity of evidence regarding the epidemiology of neonatal CVL-related thrombosis, to help clinicians identify neonates at high-risk of CVL-related thrombosis, as well as to tailor treatment based on the risks and benefits of anticoagulants in neonates

Methods: The objectives of this retrospective cohort study are 1) to determine the main risk factors of CVL-related TE in neonates admitted to the neonatal intensive care unit (NICU) and 2) to compare the effectiveness and safety between different antithrombotic treatment modalities for neonatal CVL-related TE using the Canadian Neonatal Network (CNN) database and electronic medical chart review. Neonates ≤ 28 days of life admitted to the NICU for ≥24 hours requiring a CVL with TE confirmed by imaging were included in the study. The main effectiveness outcome is the resolution of TE whereas the main safety outcome is the apparition of a major bleeding. In this study (n=39), we compared the effectiveness and safety outcomes according to antithrombotic treatment modalities (conservative vs anticoagulation).

Results: The median gestational age is 33±5 weeks and the mean birth weight is 2.1±1.1 kg. CVL responsible for TE was umbilical venous catheter (25%), umbilical arterial catheter (48%), peripherally inserted central catheter (PICC line) (8%) and peripheral arterial catheter (18%). The anticoagulation therapy tends to be more effective to achieve a partial (44% vs 18%) and complete resolution (18% vs 10%) of TE than the conservative treatment (p=0.05). However, there were no differences according to treatment groups regarding safety outcome assessed by major bleedings (p=0.2), minor bleeding (p=0.3) or transfusions (p=0.8).

Conclusion: Our results tend to suggest that anticoagulation therapy is more effective to achieve resolution of CVLs-related TE than conservative treatment without compromising the safety of neonates. However, a large multicentric study is required to evaluate the risks and benefits of anticoagulants in neonates.