Clinically symptomatic central venous catheter-related deep venous thrombosis in newborns

Abstract

The objective of this study was to evaluate the incidence of clinically symptomatic central venous catheter (CVC)-related deep venous thrombosis (DVT) in newborns and small infants and to try to identify clinical and genetic risk factors for catheter-related DVT among children with thrombotic complications. CVC was inserted in 44 consecutive infants (age range 0-90 d) during the period January 1990 to December 1995 in the neonatal intensive care unit (NICU) of Kuopio University Hospital in Kuopio. The symptoms of DVT were: syndrome of superior vena cava in 2, swelling at the CVC puncture site in 6 and repeated CVC obstructions in 2. The formation of DVT was verified by venography. Children with DVT (n = 10) had 26 (10-365, in total 623) catheter days compared with 9 d (1-155, in total 591) in patients without DVT (n = 26) (p < 0.005). The median (range) number of days from catheter insertion to diagnosis of DVT was 19 (7-210). CVC had to be removed from 11 (25%) children due to various complications. There was no DVT-related mortality. A positive family history with thromboembolic episodes at a young age was found in 3 of 10 families with a child suffering CVC-related DVT. The levels of coagulation inhibitors were evaluated at the age of 9-69 mo in all 10 (23%) children with CVC-related DVT. We detected no deficiencies in protein S, protein C or antithrombin III. One child was heterozygous for the point mutation (R506Q) in the factor V gene known to cause activated protein C resistance (APCR). We conclude that newborns with CVC are at great risk of DVT and that the aetiology of DVT can rarely be identified via measurements of coagulation inhibitors.

Congenital Prothrombotic Disorders in Children with Peripheral Venous and Arterial Thromboses

“…Indeed, while data from different registries agree on the fact that most of the thrombotic events in children are likely associated with severe underlying diseases and acquired risk factors, particularly the presence of indwelling catheters, controversy exists on whether or not and to which extent congenital prothrombotic disorders contribute to these thrombotic events [1,7,8,9]. For example, while Nowak-Göttl et al [10 ]demonstrated an increased incidence of congenital prothrombotic disorders in catheter-related thrombosis in newborns and children, in the studies by Manco-Johnson et al [11 ]and Salonvaara et al [12 ]no such association with neonatal catheter-related thrombosis was present. In one study, congenital prothrombotic risk factors have also been shown to contribute to thrombotic complications associated with CVL in children with malignancies [13].…”

Manifestations and clinical impact of pediatric inherited thrombophilia

“…One patient was heterozygous for FVL. 15 One study was performed after 2008. It showed that thrombophilia was present in none of the 13 studied neonates with CVC-related thrombosis.…”

Adsorption of proteins from infant and adult plasma to biomaterial surfaces

“…Due to the wide variation in reported incidence, it is difficult to ascertain from the existing literature whether the incidence specifically of catheter-related thromboembolism is, in fact, less in neonates than it is in adults. [26][27][28][29] Specifically designed clinical studies would be required to provide a definitive answer to this question.…”

“…24,25 However, the incidence of thromboembolic events related to the use of central venous catheters in children is significant although it is not clear whether it is less so than in adults. [26][27][28][29] Recognizing that a number of proteins, such as the contact factors, prothrombin, plasminogen, and a number of inhibitors, are present at low levels in the newborn, and in some cases in children beyond even 6 months of age, it is of interest to determine whether protein adsorption to artificial surfaces is different for infant plasma compared to adult plasma. Such differences are relevant to the prolonged use of central venous catheters in the newborn for nutritional and other purposes.…”