Pediatric Hematology/Oncology Department, Hadassah Hebrew-University Hospital, POB 12000, Jerusalem il-91120, Israel.
Semin Fetal Neonatal Med. 2011 Dec;16(6):340-4. doi: 10.1016/j.siny.2011.07.003. Epub 2011 Jul 31.
Although the use of central lines has many valuable applications in neonates and infants, they may cause serious mechanical, infectious and thrombotic complications. In fact, the use of central lines is the main cause for thrombosis in this age group. The frequency of central-line-related thrombosis in neonates and infants is reported to be as low as 1% when including only symptomatic cases, around 44% when systematically screened for thrombosis, and as high as 65% in autopsy studies. The risk factors for line-related thrombosis in neonates and infants include those associated with the underlying medical conditions, the duration of the line in situ, the placement of the umbilical artery catheter and the therapy used through the line. The contribution of inherited and acquired thrombophilia to central-line-related thrombosis is controversial, and the data are not sufficiently consistent to make a firm recommendation for thrombophilia screening for neonates and infants with central-line-related thrombosis. Most experts will recommend pursuing a thrombophilia work-up in the setting of a significant thrombosis event and will recommend avoiding thrombophilia work-up in subclinical and asymptomatic central-line-related thrombosis. The management of line-related thrombosis is based on expert opinion guidelines and is largely dependent on the type of the catheter and the further requirement of the catheter. Continuous heparin infusion through the central lines prevents catheter occlusion, but has no effect on occurrence of thrombosis. Currently no definitive recommendations exist for thromboprophylaxis in children, infants and neonates with central lines.
虽然中心静脉置管在新生儿和婴儿中有许多有价值的应用，但它们可能会导致严重的机械性、感染性和血栓性并发症。事实上，中心静脉置管是该年龄段发生血栓的主要原因。据报道，新生儿和婴儿中心静脉置管相关血栓的发生率仅包括有症状病例时低至 1%，系统筛查血栓时约为 44%，尸检研究时高达 65%。新生儿和婴儿与导管相关的血栓形成的危险因素包括与基础疾病相关的危险因素、导管在位时间、脐动脉导管的放置以及通过导管使用的治疗。遗传性和获得性血栓形成倾向对中心静脉置管相关血栓形成的影响存在争议，且数据不够一致，无法为中心静脉置管相关血栓形成的新生儿和婴儿进行血栓形成倾向筛查提出明确建议。大多数专家将建议在发生重大血栓事件时进行血栓形成倾向检查，并建议避免对亚临床和无症状的中心静脉置管相关血栓形成进行血栓形成倾向检查。导管相关性血栓形成的治疗基于专家意见指南，在很大程度上取决于导管的类型和进一步的导管要求。通过中心静脉置管持续输注肝素可防止导管阻塞，但对血栓形成的发生没有影响。目前，尚无明确的关于儿童、婴儿和新生儿中心静脉置管的血栓预防建议。
