The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

Jaffray, Julie; Bauman, Mary E.; Massicotte, Patti

doi:10.3389/fped.2017.00005

Cited by 54 publications

(48 citation statements)

References 56 publications

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“…Although the expression of these T-cell genes is not significant in neutrophils, the observation that their upstream transcriptional regulators are suppressed in neonates suggests that they are likely to have defects in the regulation of gene expression in adaptive immunity. This supports previous studies which have demonstrated neonates fail to produce a robust adaptive immune response to infection [30]. Likewise, it is well known that neutrophils communicate bidirectionally with the adaptive immune response through neutrophil development and the expression of regulatory cytosolic and cell surface molecules.…”

Section: Discussionsupporting

confidence: 90%

Neutrophil chemotaxis and transcriptomics in term and preterm neonates

Raymond

Mathias

Murphy

et al. 2017

Translational Research

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Neutrophils play a crucial role in combating life-threatening bacterial infections in neonates. Previous studies investigating neonatal cell function have been limited because of restricted volume sampling. Here, using novel microfluidics approaches, we provide the first description of neutrophil chemotaxis and transcriptomics from whole blood of human term and preterm neonates, as well as young adults. Ex vivo percent cell migration, neutrophil velocity, and directionality to fMLP were measured from whole blood using time-lapse imaging of microfluidic chemotaxis. Genome-wide expression was also evaluated in CD66b+ cells using microfluidic capture devices. Neutrophils from preterm neonates migrated in fewer numbers compared to term neonates (preterm 12.3%, term 30.5%, p=0.008) and at a reduced velocity compared to young adults (preterm 10.1 μm/min, adult 12.7 μm/min, p=0.003). Despite fewer neutrophils migrating at slower velocities, neutrophil directionality from preterm neonates was comparable to adults and term neonates. 3,607 genes were differentially expressed among the three groups (p<0.001). Differences in gene expression between neutrophils from preterm and term neonates were consistent with reduced pathogen recognition and antimicrobial activity, but not neutrophil migration, by preterm neonates. In summary, preterm neonates have significant disturbances in neutrophil chemotaxis compared to term neonates and adults, and these differences in phenotype appear at the transcriptional level to target inflammatory pathways in general, rather than in neutrophil migration and chemotaxis.

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Section: Discussionsupporting

confidence: 90%

Neutrophil chemotaxis and transcriptomics in term and preterm neonates

Raymond

Mathias

Murphy

et al. 2017

Translational Research

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“…[17][18][19] Although central venous lines have been identified as a significant risk factor for pediatric VTEs, this association was not identified in this study regarding PEs. 15,[20][21][22] Treatment of PEs uses a variety of anticoagulants, including unfractionated heparin, LMWH, warfarin, and alternative anticoagulants. Our study demonstrates a trend in treatment away from unfractionated heparin and warfarin and toward LMWH.…”

Section: Org Frommentioning

confidence: 99%

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

2018

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Key Points• Rates of pediatric PE in hospitalized patients increased 184% from 2001 to 2014.• Mortality as a result of PE in children has decreased over time and is now comparable to that from VTE.Although rare in children, pulmonary embolism (PE) can cause significant morbidity and mortality. Overall rates of venous thromboembolism (VTE) are increasing in hospitalized children. By using the Pediatric Health Information System database, we evaluated incidence, treatment, and outcome of PE in children younger than age 18 years from 2001 to 2014.Demographic characteristics for those admitted with VTE alone and those admitted with PE were compared. Rates of PE by year were compared with the number of hospital and VTE admissions. Trends in medication use were analyzed. Over the period of the study, patients with PE made up 15.8% of VTE discharges. The overall rate of PE increased 200%(P , .001). Compared with all other age groups, adolescents (age 13-18 years) had the highest prevalence (55%; P , .001), the rate of which increased from 9.8 to 24.7 per 10 000 hospital discharges (152%; P , .001), and from 17.5 to 34.1 per 100 VTE discharges (95%; P , .001). Individuals with PE had a higher mortality (8.3% vs 6%; P , .001) and were less likely to have a complex chronic condition (58% vs 65%; P , .001) than those with VTE alone. However, PE mortality rates decreased over the time period studied. AfricanAmerican and Hispanic patients were more likely to experience recurrent PE than white patients (12% and 10.7% vs 8%; P 5 .002). During the study period, the use of unfractionated heparin decreased (P , .001), and the use of low molecular weight heparin increased (P , .001). Further research is required to determine what factors contribute to the higher rate of PE in adolescents and influence recurrence in African American and Hispanic patients.

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“…Without long-term outcomes data for venous stents in children, they should be used with caution and restraint. [141][142][143] Although evidence for high morbidity and mortality in children with venous catheter-related DVT is compelling, 8,144,145 until recently, data favoring anticoagulation for CVC-related thrombi and infection prophylaxis have been relatively weak. 146 Evidence regarding the effectiveness of a shorter duration of therapy and selective use is evolving.…”

Section: Catheter-related Thrombosis and Venous Obstructionmentioning

confidence: 99%

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Baskin

Mermel

Saad

et al. 2019

J Parenter Enteral Nutr

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Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter–related complications (high‐risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life‐preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high‐need, high‐cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state‐of‐the‐art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient‐centered, multidisciplinary, collaborative, and evidence‐based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.*

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The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

Cited by 54 publications

References 56 publications

Neutrophil chemotaxis and transcriptomics in term and preterm neonates

Neutrophil chemotaxis and transcriptomics in term and preterm neonates

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

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