Sonographic detection of neonatal umbilical-artery thrombosis: clinical correlation

Seibert, Joanna J.; Taylor, Bonnie; Williamson, Susan; Williams, Brian J.; Szabo, Joanne S; Corbitt, S. L.

doi:10.2214/ajr.148.5.965

Cited by 82 publications

(71 citation statements)

References 3 publications

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“…[2][3][4][5][6]27 UACs have been in use for more than 40 years, with the reported incidence of thrombosis being almost constant, in spite of advances in the types of material used to make UACs. 28 The reported risk factors for thrombosis include the presence of an intravascular catheter, 29 duration of catheterization, 4 infusion of calcium containing fluids 5 and dehydration, sepsis, polycythemia or congenital heart disease. 30 Horgan et al 31 reported that continuous infusion of heparin, which is a standard practice worldwide, will not decrease the risk of thrombosis, but will prolong the patency of the catheter.…”

Section: Discussionmentioning

confidence: 99%

“…1 Thrombosis as a complication of UAC use is common, with an incidence range of 4.5 to 90%. [2][3][4][5] Complications of aortic thrombosis include gut ischemia, hypertension, decreased renal perfusion, complete aortic occlusion and congestive heart failure. [6][7][8][9] Thrombosis complicating UVC use is also common, with a reported incidence of 4.1 to 44%.…”

Section: Introductionmentioning

confidence: 99%

“…21,22 Ultrasound scan has been used successfully to identify large vessel thrombus. 5,26 It is a safe, readily available test that can be done at the bedside. As umbilical catheters (UCs) have a relatively high incidence of associated thrombosis, we hypothesized that having one or more of these genetic prothrombotic mutations (FVL, PTm and/or MTHFR) would increase the risk of UC-associated thrombosis.…”

Section: Introductionmentioning

confidence: 99%

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Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

et al. 2007

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Objective: To evaluate the prevalence of hereditary prothrombotic mutations, and their effect on the incidence and severity of umbilical arterial or venous catheter (UAC or UVC)-associated thrombosis.Study Design: All neonates with a UAC or UVC were studied prospectively for the presence, severity and timing of thrombosis with duplex Doppler ultrasound scan. Genetic testing for factor V Leiden (FVL), prothrombin mutation (PTm) and methylene-tetrahydrofolate reductase (MTHFR) mutations was performed using PCR and restriction fragment length polymorphism assays.Result: Umbilical catheter (UC)-associated thrombosis developed in 16/53 (31%) neonates; 23% of UACs and 22% of UVCs were associated with thrombosis. The prevalence of a significant prothrombotic mutation was present in 10/51 (20%) of infants: FVL (8%), MTHFR667 homozygosity (10%), MTHFR1298 homozygosity (2%) and PTm (0%). There was no increase in the risk of UC-associated thrombus in patients carrying these prothrombotic mutations; our study had the power to detect a 2.5-fold increased risk of thrombosis for any of these significant mutations. In addition, MTHFR667 heterozygosity was found in 41% of infants and MTHFR1298 heterozygosity in 52% and also were not associated with increased risk of UC-associated thrombus. The risk of MTHFR double heterozygosity (db het) was 14%, the risk of a significant or db het was 17/51 (33%) and the risk of any mutation was 90%.Conclusion: Prothrombotic genetic mutations are common in our Neonatal Intensive Care Unit population but do not appear to increase the risk of UC-associated thrombosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

et al. 2007

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“…2,5 It has been reported that 1% of newborn infants with catheters have symptoms indicative of thrombosis, 6 and it is estimated that the incidence of catheter-associated asymptomatic thrombosis is 20-30%. [7][8][9][10][11] An adequate management of thrombosis is generally complicated due to the extrapolation of adult management techniques. However, over the past years, major differences related to age have been observed in this condition (epidemiology, diagnostic tests, pharmacokinetics of antithrombotic agents), which have favored the use of diagnostic and therapeutic procedures appropriate for this period in life.…”

Section: Introductionmentioning

confidence: 99%

Thrombosis in newborn infants

Bacciedoni

Attie

Donato³

et al. 2016

Arch Argent Pediat

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The incidence of thrombosis is higher among newborn infants than in any other stage of pediatric development. This fact is the consequence of labile characteristics of the neonatal hemostatic system, in addition to exposure to multiple risk factors and the wide use of vascular catheters. Venous thromboses, which mainly affect the limbs, the right atrium and renal veins, are more frequently seen than arterial thromboses. A stroke may be caused by the occlusion of the arterial flow entering the brain or by occlusion of its venous drainage system. Purpura fulminans is a very severe condition that should be treated as a medical emergency, and is secondary to severe protein C deficiency or, less frequently, protein S or antithrombin deficiency. Most thrombotic events should be managed with antithrombotic therapy, which is done with unfractionated and/or low molecular weight heparins. Purpura fulminans requires protein C replacement and/or fresh frozen plasma infusion. Thrombolytic therapy is done using tissue plasminogen activator and should only be used for life-, or limb-, or organthreatening thrombosis.

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“…[7][8][9][10][11] Su manejo adecuado se complica debido a que, generalmente, se extrapolan conductas de tratamiento del adulto. Sin embargo, en los últimos años, se han evidenciado importantes diferencias relacionadas con la edad en esta patología (epidemiología, pruebas diagnósticas, farmacocinética de los antitrombóticos), lo que está permitiendo comenzar a utilizar procedimientos diagnósticos y terapéuticos acordes a este período de la vida.…”

Section: Introductionunclassified

Trombosis en el recién nacido

2016

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RESUMENLa probabilidad de padecer trombosis es mucho mayor en el período neonatal que en cualquier otra etapa pediátrica. La labilidad del particular sistema hemostático del neonato, sumada a los múltiples factores de riesgo a que está expuesto y la presencia casi constante de catéteres, son responsables de este hecho. Las trombosis venosas son más frecuentes que las arteriales y ocurren principalmente en los miembros, la aurícula derecha y las venas renales. El accidente cerebrovascular puede ser causado por la oclusión del flujo arterial que llega al cerebro o del sistema de drenaje venoso de este. La púrpura fulminans es una patología de altísima gravedad, que debe ser considerada una emergencia médica y se debe a la deficiencia grave de proteína C o, menos frecuentemente, de proteína S o antitrombina. La mayoría de los episodios trombóticos tienen indicación de tratamiento anticoagulante, que se puede realizar con heparina no fraccionada y/o con heparina de bajo peso molecular. La púrpura fulminans requiere terapia de sustitución con proteína C y/o plasma fresco. El tratamiento trombolítico se realiza con activador tisular del plasminógeno y debe quedar reservado solo para aquellas trombosis cuya localización implique compromiso de vida o pérdida de un órgano o de un miembro. veces superior a cualquier otra edad pediátrica, en especial en aquellos niños críticamente enfermos o que precisan catéter central. Este último es, sin duda, el factor de riesgo más importante para el desarrollo de tromboembolismo, tanto arterial como venoso. Aproximadamente, el 90% de los eventos tromboembólicos están asociados a algún tipo de catéter.1,2 Este favorece la ocurrencia de trombosis a través de distintos m e c a n i s m o s , y a s e a a c t u a n d o aisladamente o en forma combinada entre ellos: provoca daño mecánico de la pared vascular y enlentecimiento o interrupción del flujo sanguíneo; está fabricado con material que es potencialmente trombogénico; y es utilizado para infundir sustancias que dañan la pared vascular.3 Los otros factores predisponentes son asfixia perinatal, prematuridad, trastornos cardíacos, sepsis, hipoxia y diabetes materna. Los estados protrombóticos hereditarios juegan un rol poco importante en este período. 4 La incidencia global de tromboembolismo en recién nacidos hospitalizados es de aproximadamente 2,4 por 1000 admisiones.2,5 Se ha comunicado que el 1% de los neonatos con catéte-res presentan síntomas sugestivos de trombosis, 6 y se estima que la incidencia de trombosis asintomática asociada a catéteres está en el orden del 20% al 30%. [7][8][9][10][11] Su manejo adecuado se complica debido a que, generalmente, se extrapolan conductas de tratamiento del adulto. Sin embargo, en los últimos años, se han evidenciado importantes diferencias relacionadas con la edad en esta patología (epidemiología, pruebas diagnósticas, farmacocinética de los antitrombóticos), lo que está permitiendo comenzar a utilizar procedimientos diagnósticos y terapéuticos acordes a este período de la vida. CARACTERÍSTIC...

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Sonographic detection of neonatal umbilical-artery thrombosis: clinical correlation

Cited by 82 publications

References 3 publications

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

Thrombosis in newborn infants

Trombosis en el recién nacido

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