Eason Alexander J, Crethers Danielle, Ghosh Santu, Stansfield Brian K, Polimenakos Anastasios C
Division of Neonatology, Department of Pediatrics, Augusta University, Augusta, GA, USA.
Division of Pediatric and Congenital Heart Surgery, Department of Surgery, Augusta University, Augusta, GA, USA.
Pediatr Cardiol. 2020 Oct;41(7):1340-1345. doi: 10.1007/s00246-020-02383-2. Epub 2020 May 29.
Central vascular thrombosis (CVT) in critically ill neonates carries significant clinical implications. Neonates with congenital heart disease (CHD) awaiting cardiac intervention might be associated with increased risk of thrombosis. Outcome analysis was undertaken. An analysis of 77 neonates with CHD who were admitted to the NICU prior to cardiac intervention between January 2015 and December 2016 was undertaken. Patients requiring extracorporeal life support prior to any cardiac intervention, or receiving prophylactic anticoagulation not related to central vascular catheter (CVC) were excluded. Diagnosis of CVT was provided based on clinical indication and verified with imaging that warranted anticoagulation therapy. Location of CVC and extent of CVT along with treatments, outcomes, and vascular access types and durations were assessed. Logistic regression multivariate analysis was used to assess predictors of outcome. Neonates with CHD were complicated with CVT in 10.4%. Longer duration of CVC was also associated with thrombosis in neonates with CHD (72.7 days vs. 29.3 days, p < 0.001). Independent predictors of outcome included lower gestational age and CHD with single-ventricle (SV) anatomy (p < 0.05). In neonates with CHD awaiting cardiac intervention risk of CVT is substantial. Duration CVC, lower gestational age and SV anatomy are risk determinants of outcome. Standardized development of customized surveillance protocols tailored to this unique subsets of neonates and adherence to quality guidelines can influence outcome.
危重新生儿的中心血管血栓形成（CVT）具有重大临床意义。患有先天性心脏病（CHD）并等待心脏介入治疗的新生儿可能血栓形成风险增加。进行了结局分析。对2015年1月至2016年12月期间在心脏介入治疗前入住新生儿重症监护病房（NICU）的77例CHD新生儿进行了分析。排除在任何心脏介入治疗前需要体外生命支持或接受与中心血管导管（CVC）无关的预防性抗凝治疗的患者。根据临床指征诊断CVT，并通过需要抗凝治疗的影像学检查进行验证。评估CVC的位置、CVT的范围以及治疗方法、结局、血管通路类型和持续时间。采用逻辑回归多变量分析评估结局的预测因素。CHD新生儿中CVT的发生率为10.4%。CVC使用时间较长也与CHD新生儿的血栓形成有关（72.7天对29.3天，p＜0.001）。结局的独立预测因素包括较低的胎龄和单心室（SV）解剖结构的CHD（p＜0.05）。在等待心脏介入治疗的CHD新生儿中，CVT风险很高。CVC使用时间、较低的胎龄和SV解剖结构是结局的风险决定因素。针对这一独特新生儿亚群制定标准化的定制监测方案并遵守质量指南可影响结局。
