Robinson Victoria, Achey Meredith A, Nag Uttara P, Reed Christopher R, Pahl Kristy S, Greenberg Rachel G, Clark Reese H, Tracy Elisabeth T
Duke University School of Medicine, Durham, NC, USA.
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
J Thromb Haemost. 2021 Feb;19(2):400-407. doi: 10.1111/jth.15144. Epub 2021 Jan 5.
Thrombosis in the neonatal population is rare, but increasing. Its incidence and management are not well understood.
To investigate the incidence, associated factors, and management of thrombosis in the neonatal intensive care unit (NICU) population.
PATIENTS/METHODS: We performed a retrospective cohort study of infants admitted to a Pediatrix Medical Group-affiliated NICU from 1997 through 2015. We determined the prevalence of venous and arterial thrombosis, and assessed demographic characteristics and known risk factors. Categorical variables were compared with the Pearson χ test and continuous variables with Wilcoxon rank-sum tests. Stepwise logistic regression was used to identify associated factors. The primary outcome was incidence of thrombosis. Secondary analyses investigated correlations between clinical and demographic characteristics and thrombosis.
Among 1 158 755 infants, we identified 2367 (0.20%) diagnosed with thrombosis. In a multivariable regression analysis, prematurity, male sex, congenital heart disease, sepsis, ventilator support, vasopressor receipt, central venous catheter, invasive procedures, and receipt of erythropoietin were associated with increased risk of thrombosis, while Black race and Hispanic ethnicity were associated with reduced risk. The majority of infants diagnosed with thrombosis (73%) received no anticoagulation, but anticoagulant use in infants with thrombosis was higher than those without (27% versus 0.2%, P < .001). Thrombosis in infants was associated with higher mortality (11% versus 2%, P < .001) and longer hospital stays (57 days, [interquartile range (IQR) 28--100] versus 10 days, [IQR 6--22], P < .001).
In the largest national study to date, we found that thrombosis in NICU patients is associated with prematurity, low birth weight, sepsis, and invasive procedures.
新生儿血栓形成较为罕见，但呈上升趋势。其发病率及治疗方法尚未完全明确。
研究新生儿重症监护病房（NICU）中血栓形成的发病率、相关因素及治疗方法。
患者/方法：我们对1997年至2015年在隶属于Pediatrix医疗集团的NICU住院的婴儿进行了一项回顾性队列研究。我们确定了静脉和动脉血栓形成的患病率，并评估了人口统计学特征和已知风险因素。分类变量采用Pearson χ检验进行比较，连续变量采用Wilcoxon秩和检验进行比较。采用逐步逻辑回归分析确定相关因素。主要结局指标为血栓形成的发病率。二级分析调查了临床和人口统计学特征与血栓形成之间的相关性。
在1158755名婴儿中，我们确定有2367名（0.20%）被诊断为血栓形成。在多变量回归分析中，早产、男性、先天性心脏病、败血症、呼吸机支持、血管活性药物使用、中心静脉导管、侵入性操作以及促红细胞生成素的使用与血栓形成风险增加相关，而黑人种族和西班牙裔与血栓形成风险降低相关。大多数被诊断为血栓形成的婴儿（73%）未接受抗凝治疗，但血栓形成婴儿的抗凝治疗使用率高于未患血栓的婴儿（27%对0.2%，P <.001）。婴儿血栓形成与较高的死亡率（11%对2%，P <.001）和更长的住院时间相关（57天，[四分位间距（IQR）28 - 100]对10天，[IQR 6 - 22]，P <.001）。
在迄今为止最大规模的全国性研究中，我们发现NICU患者的血栓形成与早产、低出生体重、败血症和侵入性操作有关。
