ABSTRACT
Zbigniew Krasiński, Prof
Chef
1- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences
Poznan, Wielkopolskie, Poland
Newborns treated in the neonatal intensive care units (NICU) are predisposed to several complications of invasive procedures. One of them is vein thrombosis. The most commonly identified risk factor for thrombosis is the presence of a central vein catheter (CVC). The aim of this study was to evaluate the most important risk factors of central vein thrombosis during the neonatal period and to evaluate clinical manifestations well as treatment outcomes.
Methods:
This case-control observational study was performed in the tertiary NICU at the University Hospital in Poznan, Poland, between January 2013 and June 2016. The medical charts of all neonates with thrombotic events were reviewed to determine risk factors, thrombus localization, administered treatment, and outcome. Newborns with catheter-related vein thrombosis diagnosed during hospitalization were included. The control group consisted of consecutive neonates with the same gestational age with central vein catheters without thrombotic events. The presence of thrombosis was determined by ultrasonography performed by a neonatologist or radiologist.
Results:
The analysis comprised 8382 neonates born over 3.5 years. CVC was established in 729 newborns. A total of 16 patients were diagnosed with CVC-related thrombosis. An additional 3 neonates had non-CVC-related thrombosis (renal vein thrombosis) and were not included in the analysis. The mean gestational age of the study population was 30 weeks of gestation, and the mean birth weight was 1550g. CVC placement was the main risk factor for thrombotic events. Other statistically significant risk factors were: asphyxia, infection, and duration of CVC usage. An increase in the number of thromboses was observed in the study period - from 4 in the first time interval (2013-2014) to 12 in the second time interval (2015-2016). The majority of neonates (62.5%) had no clinical signs of thrombosis. The most common localization of the thrombosis was the vena cava inferior (37.5%) and portal vein (25.5%). Follow-up with ultrasound exam performed within 3 months after detection of thrombosis showed complete resolution in 10 cases (62.5%). In 4 cases (25.0%), there was only partial resolution of a thrombus. In two infants (12.5%), we did not observe any clot resolution. None of the patients died because of the thrombosis. All infants were treated with intravenous or subcutaneous enoxaparin for the period of 6 weeks to even 3 months.
Conclusions:
Central line catheter is the most important risk factor for thrombosis among newborns. The problem of thrombosis in the neonatal period is growing because the incidence of central lines catheterization increased. Also the experience in the diagnosis of incidental thrombosis increased over time. Therefore neonatologists should be trained in routine ultrasound in infants with CVC.