Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, OH.
J Pediatr. 2018 Apr;195:28-32. doi: 10.1016/j.jpeds.2017.12.015. Epub 2018 Feb 2.
To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit.
A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately.
The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75% vs 49%; P < .01) were of extremely preterm gestational age (22-27 weeks; 26% vs 15.0%; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53% vs 32.9%; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95% CI, 1.03-4.35; P = .04) and blood stream infection (AOR, 3.47; 95% CI, 1.30-9.24; P = .01).
The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.
确定入住新生儿重症监护病房的患病新生儿发生静脉和动脉血栓形成的相关风险因素。
这是一项于 2010 年 1 月至 2014 年 3 月在 2 个中心开展的病例对照研究，研究使用了儿童医院新生儿数据库数据集。病例组为在新生儿重症监护病房住院期间被诊断患有动脉或静脉血栓形成的新生儿；对照组为按照胎龄和是否存在中央血管通路装置以 1:4 的比例进行匹配。分别对静脉和动脉血栓形成进行了两变量和条件逻辑回归分析。
新生儿血栓形成的总体发生率为每 1000 例入院 15.0 例。与无血栓形成的新生儿相比，患有血栓形成的新生儿中中央血管通路装置的存在比例更高（75%比 49%；P<0.01），极早产儿（22-27 周；26%比 15.0%；P<0.05）和在新生儿重症监护病房的停留时间≥31 天的比例更高（53%比 32.9%；P<0.01）。最终纳入 64 例符合条件的血栓形成患者和 4623 例对照进行分析。在条件多变量逻辑回归模型中，静脉血栓形成与男性（比值比，2.12；95%置信区间，1.03-4.35；P=0.04）和血流感染（比值比，3.47；95%置信区间，1.30-9.24；P=0.01）显著相关。
与之前的报告相比，我们的新生儿人群中血栓形成的发生率更高。在匹配中央血管通路装置和胎龄后，男性和血流感染是新生儿静脉血栓形成的独立危险因素。应使用来自多中心数据的更大队列来证实研究结果并制定血栓预防策略。
