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Colella M, Zanin A, Toumazi A, Bourmaud A, Boizeau P, Guilmin-Crepon S, Leick N, Khat S, Alison M, Baud O, Biran V. Association between Portal Vein Thrombosis after Umbilical Vein Catheterization and Neonatal Asphyxia. Neonatology 2024; 121:478-484. [PMID: 38522417 DOI: 10.1159/000537902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Neonatal portal vein thrombosis (PVT) is frequently related to umbilical venous catheterization (UVC), but risk factors remain unclear. This study aims to analyze the variables associated to PVT in near- to full-term newborns with UVC, with a focus on newborns exposed to controlled therapeutic hypothermia (CTH) for hypoxic ischemic encephalopathy (HIE). METHODS This is retrospective cohort study of infants delivered at or after 36 weeks and with a birthweight over 1,500 g. All infants were assessed for UVC location and PVT using ultrasonography performed between day 5 and day 10 after catheterization. RESULTS Among 213 eligible patients, PVT was diagnosed in 57 (27%); among them, 54 (95%) were localized in the left portal vein branch. With all significant factors in univariate analysis considered, higher gestational age at birth (adjusted OR 1.35; 95% CI: 1.12-1.64, p = 0.002) and duration of UVC placement (adjusted OR 1.36; 95% CI: 1.11-1.67, p = 0.004) were the main risk factors of PVT. Among 87 infants who were cooled for HIE, 31 (36%) had PVT compared to 26 (21%) in infants without CTH. Using a multivariate model including variables linked to treatment procedures only, an increased PVT incidence was statistically associated with UVC duration (adjusted OR 1.33; 95% CI: 1.08; 1.63, p = 0.01) and CTH (adjusted OR 1.94; 95% CI: 1.04-3.65, p = 0.04). CONCLUSION Left PVT was frequently observed in near- to full-term neonates with UVC. Among factors linked to treatment procedures, both duration of UVC and CTH exposure for HIE were found to be independent risk factors of PVT.
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Affiliation(s)
- Marina Colella
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
- I2D2, Inserm 1141, University Paris Cité, Paris, France
| | - Anna Zanin
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
- Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Artemis Toumazi
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Aurélie Bourmaud
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Priscilla Boizeau
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Sophie Guilmin-Crepon
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Noémie Leick
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
| | - Sophea Khat
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
| | - Marianne Alison
- I2D2, Inserm 1141, University Paris Cité, Paris, France
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
| | - Olivier Baud
- I2D2, Inserm 1141, University Paris Cité, Paris, France
- Division of Neonatology and Pediatric Intensive Care, Children's University Hospital and University of Geneva, Geneva, Switzerland
| | - Valerie Biran
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
- I2D2, Inserm 1141, University Paris Cité, Paris, France
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Barone G, Pittiruti M, Prontera G, Ancora G, D'Andrea V. A novel neonatal protocol for Safe Insertion of Umbilical Venous Catheters (SIUVeC): Minimizing complications in placement and management. J Vasc Access 2024:11297298241236220. [PMID: 38436297 DOI: 10.1177/11297298241236220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Insertion of umbilical venous catheters is a common procedure in neonatal intensive care. Though sometimes lifesaving, this maneuver is potentially associated with early and late complications, some of which may be severe and even life threatening (catheter malposition, hepatic lesions, venous thrombosis, pericardial effusion, etc.). The recent literature suggests several operative strategies that, if adopted systematically, may significantly reduce the incidence of both early and late catheter related complications. This paper describes a standardized protocol (Safe Insertion Umbilical Venous Catheter = SIUVeC) which incorporates such novel strategies, with the goal of minimizing the complications related to this procedure.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Emilia Romagna, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Giorgia Prontera
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Emilia Romagna, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
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Perme T. Central Lines and Their Complications in Neonates: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 11:26. [PMID: 38255340 PMCID: PMC10814986 DOI: 10.3390/children11010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the risk factors associated with complications has to be an important part of neonatal care quality management. Presented here is a case of a preterm neonate with cardiac tamponade caused by UVC tip migration. Among complications of central lines are CLABSI, with an incidence of 3 to 21 per 1000 catheter days, and portal vein thrombosis, which is common but probably under-recognised, whereas other mechanical complications such as pericardial and pleural effusions are rare, with an incidence of less than 1%. Complications can cause injury to the neonates, as well as increase the costs of health services because of increases in the length of stay in the NICU. It is recommended that the catheter tip location is confirmed either by X-ray or ultrasonography. In order to minimise the risk of CLABSI, the use of bundles is recommended. Certain recommendations need to be followed when using different types of catheters. Future research is aimed at novel ways of central line securement to minimise mechanical complications and the use of antimicrobial catheters to reduce the rate of CLABSI.
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Affiliation(s)
- Tina Perme
- Neonatal Intensive Care Unit, Department for Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Galdo F, Trappan A, Cossovel F, Rodriguez-Perez C, Ronfani L, Montaldo P, Bibalo C, Travan L, Risso FM. Ultrasonographic measurements of the inferior vena cava diameter in newborns: is it a useful tool for choosing an umbilical venous catheter? Front Pediatr 2023; 11:1268622. [PMID: 38046676 PMCID: PMC10690934 DOI: 10.3389/fped.2023.1268622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/12/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives The primary outcomes of this study were to evaluate the diameters of the inferior vena cava (IVC) in a cohort of newborns and the correlation between newborn weight and IVC diameter. The secondary outcome was to evaluate the concordance between the measurements performed by the two investigators. Methods Two blind examiners performed an ultrasonographic (US) evaluation of the IVC diameter in neonates with a weight ranging from 2 to 4 kg. The exclusion criteria included hemodynamic instability, known vascular malformations, and major congenital malformations. Results A total of 143 neonates were enrolled between June 2019 and January 2021. All the US examinations were performed in the first 3 days of life. After dividing the patients into two groups according to their weight at the time of examination (2.0-2.99 kg and 3.0-4.0 kg), the median IVC diameters measured by examiner 1 were 3.1 mm (interquartile range 2.8-3.4) and 3.4 mm (interquartile range 2.9-3.8) (p = 0.003) for the two groups, respectively. The median IVC diameters measured by examiner 2 were 3.1 mm (interquartile range 2.6-3.3) and 3.3 mm (interquartile range 2.8-3.8) (p = 0.004) for the two groups, respectively. The intraclass correlation coefficient was 0.93 (95% CI: 0.90-0.95). Conclusion The IVC diameter values varied widely from 1.2 to 5.2 mm in newborns weighing 2-4 kg, and a low correlation between newborn weight and IVC diameter was found, so measuring IVC diameter may be a recommended step prior to inserting a umbilical venous catheter (UVC). The concordance between operators was good. We contemplated that the IVC diameter could be a potentially useful tool to identify the most appropriate UVC, thus reducing the risk of catheter-related thrombosis.
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Affiliation(s)
- Francesca Galdo
- Neonatal Intensive Care Unit, Institute of Child and Maternal Health, IRCSS Burlo Garofolo, Trieste, Italy
| | - Antonella Trappan
- Neonatal Intensive Care Unit, Institute of Child and Maternal Health, IRCSS Burlo Garofolo, Trieste, Italy
| | | | - Carmen Rodriguez-Perez
- Neonatology and Neonatal Intensive Care Unit, ASST Spedali Civili, Ospedale Dei Bambini, Brescia, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo,”Trieste, Italy
| | - Paolo Montaldo
- Department of Neonatal Intensive Care, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
- Department of Brain Sciences, Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Cristina Bibalo
- Azienda Sanitaria Universitaria Giuliano Isontino, Trieste, Italy
| | - Laura Travan
- Neonatal Intensive Care Unit, Institute of Child and Maternal Health, IRCSS Burlo Garofolo, Trieste, Italy
| | - Francesco Maria Risso
- Neonatology and Neonatal Intensive Care Unit, ASST Spedali Civili, Ospedale Dei Bambini, Brescia, Italy
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Barone G, D'Andrea V, Ancora G, Cresi F, Maggio L, Capasso A, Mastroianni R, Pozzi N, Rodriguez-Perez C, Romitti MG, Tota F, Spagnuolo F, Raimondi F, Pittiruti M. The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns. Eur J Pediatr 2023; 182:3385-3395. [PMID: 37195350 DOI: 10.1007/s00431-023-04984-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/18/2023]
Abstract
In most NICUs, the choice of the venous access device currently relies upon the operator's experience and preferences. However, considering the high failure rate of vascular devices in the neonatal population, such clinical choice has a critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems in line with the current scientific evidence. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in the neonatal population. After a systematic review of the available evidence, the panel of the consensus (which included Italian neonatologists specifically experts in this area) has provided structured recommendations answering four sets of questions regarding (1) umbilical venous catheters, (2) peripheral cannulas, (3) epicutaneo-cava catheters, and (4) ultrasound-guided centrally and femorally inserted central catheters. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice. Conclusion: The goal of the present consensus is to offer a systematic set of recommendations on the choice of the most appropriate vascular access device in Neonatal Intensive Care Unit.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy.
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Sant'Anna Hospital, University of Turin, Città Della Salute E Della Scienza, Turin, Italy
| | - Luca Maggio
- Neonatology and Neonatal Intensive Care Unit, AO San Camillo Forlanini, Rome, Italy
| | - Antonella Capasso
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | | | - Nicola Pozzi
- Neonatal Intensive Care Unit, San Pio Hospital, Benevento, Italy
| | - Carmen Rodriguez-Perez
- Neonatology and Neonatal Intensive Care Unit, ASST Spedali Civili, Ospedale Dei Bambini, Brescia, Italy
| | | | - Francesca Tota
- Neonatal Intensive Care Unit, Ospedale S. Chiara, APSS, Trento, Italy
| | - Ferdinando Spagnuolo
- Neonatal Intensive Care Unit, AOU Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Raimondi
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Hess S, Poryo M, Böttger R, Franz A, Klotz D, Linnemann K, Ott T, Pöschl J, Schroth M, Stein A, Ralser E, Reutter H, Thome UH, Wieg C, Ehrlich A, Ruckes C, Wagenpfeil S, Zemlin M, Papan C, Simon A, Bay J, Meyer S. Umbilical venous catheter- and peripherally inserted central catheter-associated complications in preterm infants with birth weight < 1250 g : Results from a survey in Austria and Germany. Wien Med Wochenschr 2023; 173:161-167. [PMID: 35939216 PMCID: PMC10147741 DOI: 10.1007/s10354-022-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterm infants but have been associated with a number of serious complications. We performed a survey in Austria and Germany to assess the use of UVCs and PICCs in preterm infants with a birth weight < 1250 g and associated rates of catheter-related adverse events. METHODS Electronic survey of participating centers of the NeoVitaA trial. Main outcome parameter was the reported rates of UVC- and PICC-associated complications (infection, thrombosis, emboli, organ injury, arrhythmia, dislocation, miscellaneous). RESULTS In total, 20 neonatal intensive care units (NICU) providing maximal intensive care in Austria and Germany (level I) were contacted, with a senior neonatologist response rate of 12/20 (60%). The reported rates for UVC with a dwell time of 1-10 days were bacterial infection: 4.2 ± 3.4% (range 0-10%); thrombosis: 7.3 ± 7.1% (0-20%); emboli: 0.9 ± 2.0% (0-5%); organ injury: 1.1 ± 1.9% (0-5%); cardiac arrhythmia: 2.2 ± 2.5% (0-5%); and dislocation: 5.4 ± 8.7% (0-30%); and for PICCs with a dwell time of 1-14 days bacterial infection: 15.0 ± 3.4% (range 2.5-30%); thrombosis; 4.3 ± 3.5% (0-10%); emboli: 0.8 ± 1.6% (0-5%); organ injury: 1.5 ± 2.3% (0-5%); cardiac arrhythmia: 1.5 ± 2.3% (0-5%), and dislocation: 8.5 ± 4.6% (0-30%). CONCLUSION The catheter-related complication rates reported in this survey differed between UVCs and PICCs and were higher than those reported in the literature. To generate more reliable data on this clinically important issue, we plan to perform a large prospective multicenter randomized controlled trial investigating the non-inferiority of a prolonged UVC dwell time (up to 10 days) against the early change (up to 5 days) to a PICC.
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Affiliation(s)
- Steffi Hess
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Ralf Böttger
- University Children's Hospital, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Axel Franz
- University Children's Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Knud Linnemann
- University Children's Hospital, Greifswald University Hospital, Greifswald, Germany
| | - Torsten Ott
- University Children's Hospital, University Hospital Muenster, Münster, Germany
| | - Johannes Pöschl
- University Children's Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anja Stein
- University Children's Hospital, Essen University Hospital, Essen, Germany
| | - Elisabeth Ralser
- University Children's Hospital, Medical University of Innsbruck, Innsbruck, Austria
| | - Heiko Reutter
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatric and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich H Thome
- University Children's Hospital, University of Leipzig Medical Center, Leipzig, Germany
| | - Christian Wieg
- Children's Hospital Aschaffenburg, Aschaffenburg, Germany
| | - Anne Ehrlich
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Johannes Gutenberg-Universität, Mainz, Germany
| | - Christian Ruckes
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Johannes Gutenberg-Universität, Mainz, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany
| | - Cihan Papan
- Department of Medical Microbiology and Hospital Hygiene, Saarland University Medical Center, Homburg, Germany
| | - Arne Simon
- Department of Pediatric Hematology and Oncology, Infectious Diseases, Saarland University Medical Center, Homburg, Germany
| | - Johannes Bay
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany
| | - Sascha Meyer
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany.
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Hess S, Poryo M, Ruckes C, Papan C, Ehrlich A, Ebrahimi-Fakhari D, Bay JS, Wagenpfeil S, Simon A, Meyer S. Assessment of an umbilical venous catheter dwell-time of 8-14 days versus 1-7 days in very low birth weight infacts (UVC - You Will See): a pilot single-center, randomized controlled trial. Early Hum Dev 2023; 179:105752. [PMID: 36958105 DOI: 10.1016/j.earlhumdev.2023.105752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Umbilical venous catheters (UVCs) are used for central vascular access in preterm infants, but controversy exits with regard to the optimum dwell-time. PATIENTS AND METHODS Prospective, randomized controlled trial at a level III University neonatal intensive care unit (NICU), comparing a UVC dwell-time of 1-7 days (control group) to 8-14 days (intervention group) in very low birth weight (VLBW) infants. PRIMARY OUTCOME PARAMETER Number of infants requiring additional peripherally inserted central catheters (PICC) after removal of UVC. SECONDARY OUTCOME PARAMETERS Total number of central lines (CL = UVC and PICCs) until time point of full enteral feeds (130-160 mL/kg/d), total number of intravenous vascular catheters, number of CL-associated complications (infection, thrombosis/emboli, organ injury, secondary CL dislocation), number of X-rays for assessment of CL positioning, and days of therapy (DOT) (teicoplanin) for CL-associated blood stream infections (CLABSI). RESULTS Of 116 patients screened for eligibility, 63 patients were enrolled - control group: 31 infants, mean gestational age (GA) 280 weeks (standard deviation (SD) 2.6 weeks), mean birth weight (BW) 988.9 g (SD 322.0 g); intervention group: 32 infants, mean GA 285 weeks (SD 3.0 weeks), mean BW 1078.9 g (SD 324.6 g). In the control group, 28 infants required additional PICCs versus 16 in the intervention group (p < 0.001); total number of CLs: control group n = 58 versus intervention group n = 28; p < 0.001, and the total number of venous vascular devices was also significantly higher in the control group (109 versus 61; p = 0.04). No significant differences were seen with regard to CL-associated complications (p = 0.09). The number of X-rays for assessment of correct CL-position significantly lower in the intervention group (144 versus 96; p = 0.03). In the intervention group, length of hospital stay was significantly shorter (88.1 (SD: 35.3 days) versus 68.1 (SD: 32.6 days); p = 0.03) and GA significantly lower at discharge from the hospital (404: SD: 33 weeks) versus 385: SD: 25 weeks; p = 0.02. No differences existed with regard to neonatal morbidities and mortality at 36 weeks gestational age. CONCLUSIONS A longer UVC dwell-time of up to 14 days significantly decreased the number of painful invasive vascular procedures and radiation exposure, and shortened the length of the hospital stay. The findings of our pilot study should be confirmed in a larger, multi-center RCT with the primary focus on catheter-associated complications.
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Affiliation(s)
- Steffi Hess
- Saarland University Medical Center, Department of General Pediatrics and Neonatology, Homburg, Germany
| | - Martin Poryo
- Saarland University Medical Center, Department of Pediatric Cardiology, Homburg, Germany
| | - Christian Ruckes
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Iohannes Gutenberg-University, Mainz, Germany
| | - Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Anne Ehrlich
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Iohannes Gutenberg-University, Mainz, Germany
| | | | - Johannes Saaradonna Bay
- Saarland University Medical Center, Department of General Pediatrics and Neonatology, Homburg, Germany
| | - Stefan Wagenpfeil
- Saarland University Medical Center, Institute for Medical Biometry, Epidemiology, and Medical Informatics (IMBEI), Homburg, Germany
| | - Arne Simon
- Saarland University Medical Center, Department of Pediatric Hematology and Oncology, Infectious Diseases, Homburg, Germany
| | - Sascha Meyer
- Saarland University Medical Center, Department of General Pediatrics and Neonatology, Homburg, Germany; Franz-Lust Klinik für Kinder- und Jgendmedizin, Karlsruhe, Germany.
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8
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Intracardiac Thrombi in Preterm Infants-A Case Study and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13040764. [PMID: 36832252 PMCID: PMC9955841 DOI: 10.3390/diagnostics13040764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Intracardiac thrombi in preterm infants are not common but may lead to fatal outcomes. Predisposing and risk factors include small vessel size, hemodynamic instability, immaturity of the fibrinolytic system, indwelling central catheters and sepsis. In this paper, we present our own experience with a case of a catheter-related right atrial thrombus in a preterm infant, which was successfully treated with an aspiration thrombectomy. Then, we review the literature on intracardiac thrombosis in preterm infants: epidemiology, pathophysiology, clinical signs, echocardiographic diagnostic features and treatment options are discussed.
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9
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Soonsawad S, Kieran EA, Ting JY, AlonsoPrieto E, Panczuk JK. Factors Associated with Umbilical Venous Catheter Malposition in Newborns: A Tertiary Center Experience. Am J Perinatol 2022; 39:1805-1811. [PMID: 33853146 DOI: 10.1055/s-0041-1726385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Umbilical venous catheters (UVC) are widely used in neonatal intensive care (NICU). Noncentral catheter position is known to be associated with multiple adverse complications; however, risk factors for catheter malposition are unclear. This work aimed to identify clinical risk factors and complications associated with UVC malposition in neonates admitted in an NICU. STUDY DESIGN A retrospective chart review was performed of inborn babies admitted to BC Women's Hospital NICU with UVC inserted in their first 7 days between July 2016 and June 2018. Infant and maternal demographic, radiograph, UVC-related data, and complications were reviewed. RESULTS A total of 257 infants had UVC placed; 158 (61%) and 99 (39%) were in central and noncentral positions after initial placement, respectively. Of initially central-placed UVCs, a further 35 (22%) were pulled back or migrated to malposition on follow-up X-ray. Multivariable logistic regression analysis revealed the use of larger UV (5 Fr) catheter (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.1-5.6, p = 0.026) and escalation of respiratory support mode (OR: 1.7, 95% CI: 1.0-2.8, p = 0.049) as significant predictors of catheter malposition. CONCLUSION Noncentral UVC position as well as migration were common after initial placement in this cohort. The use of larger size UV catheters and increasingly invasive respiratory support were risk factors associated with higher incidence of UVC malposition. Ongoing surveillance of UVC position is thus recommended. KEY POINTS · More than one-third of UV catheters were not in central position after the initial placement.. · Large size UV catheters and increasingly invasive respiratory support were risk factors for UV malposition.. · High incidence of UVC migration was found after initial central placement, warranting surveillance..
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Affiliation(s)
- Sasivimon Soonsawad
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada.,Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Emily A Kieran
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
| | - Joseph Y Ting
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Esther AlonsoPrieto
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Julia K Panczuk
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
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10
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Gordeeva OB, Vashakmadze ND, Karaseva MS, Babaykina MA, Zhurkova NV, Soloshenko MA, Kretova EV. Modern Aspects of Anticoagulation System Disorders Diagnosis in Children with Different Polymorphisms in Coagulation Genes. Initial Results. PEDIATRIC PHARMACOLOGY 2022. [DOI: 10.15690/pf.v19i4.2444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background. Hemostatic system pathology is topical and poorly studied issue in pediatrics. One of the main causes of coagulation pathway disorders associated with thrombotic events is abnormality in various parts of the hemostatic system. Vascular accidents are commonly caused by anticoagulation system factors deficiency. Conventionally, thrombosis is a common event in adult patients, and there is no adequate attention to disorders of primary physiological anticoagulants system in children. More often acquired anticoagulant proteins deficiency develops in presence of various pathological conditions, especially after the past infectious diseases. All these diseases (thrombophilia, trombotic events, cardiovascular pathology, nervous system diseases, genetic diseases) can occur separately and in association with each other, plus clinical picture of coagulation events may be similar. Objective. The aim of the study is to evaluate changes in the physiological anticoagulants system in children with different pathologies who have polymorphic variants in coagulation genes and who had new coronavirus infection. Methods. The study included 33 children who had severe coronavirus infection in family clusters and had severe chronic pathology potentially associated with disorders of the coagulation system (nervous system damage, hypertrophic cardiomyopathy, hereditary monogenic syndromes, hemato-mesenchymal dysplasia syndrome). All children underwent complete examination including clinical examination, laboratory, and instrumental diagnostics. Results. Preliminary study results indicate significant incidence of polymorphic variants in coagulation genes (one third of children with various diseases from the study). Some children had decreased activity of anticoagulation system glycoproteins (from 6% to 36%) that confirmed the topicality of the examination of anticoagulation system factors deficiency and the need for further dynamic follow-up, as well as revealing of trombophilia predictors in children in selected target groups. Study on revealing anticoagulation system disorders and mutations in coagulation genes will predict the risk of thrombotic disorders. Conclusion. The obtained results have confirmed the significant role of the ongoing study for comprehensive assessment of hemostatic system disorders in children. That will allow us to optimize the approach to diagnosis and personalize the management strategy for patients with different chronic pathologies and disorders of the natural anticoagulants system. The study is currently ongoing.
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Affiliation(s)
- Olga B. Gordeeva
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Nato D. Vashakmadze
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Maria S. Karaseva
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Marina A. Babaykina
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Natalia V. Zhurkova
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Margarita A. Soloshenko
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Elena V. Kretova
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
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11
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Paes B, Chan AKC, Shaik M, Patel D, Bhatt MD. Epidemiology, diagnosis and management of neonatal thrombosis: a single-center cohort study. Blood Coagul Fibrinolysis 2022; 33:83-89. [PMID: 35001043 DOI: 10.1097/mbc.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of neonatal venous and arterial thrombosis ranges from 6.9 to 15/1000 neonatal ICU (NICU) admissions, and is likely an underestimate based on population demographics, frequency of surveillance and vascular catheterization. This retrospective study involving 234 infants reviewed the epidemiology, diagnosis, and management of neonatal thrombosis in a single, tertiary care institution over more than 10 years. The incidence of thrombosis was 25/1000 NICU admissions, with a preterm to term infant ratio of 1.5 : 1 and a slightly higher proportion of male sex (55.1%). The mean (range) gestational age and birth weight was 33.8 weeks (23-41.6) and 2360 g (512-5890). The median age (IQR) of thrombus diagnosis was 7 (3-17) days. Portal vein thrombosis was most prevalent (59.4%) compared with other sites of thrombosis. Almost three-quarter (171/234; 73.1%) of the thrombotic episodes were line-related, while infection and surgery were associated with 19.7% (46/234) and 10.7% (25/234), respectively. Twenty patients (8.3%) were screened for thrombophilia and 3 were positive; 2 for antithrombin deficiency, 1 for factor V Leiden gene mutation. Subjects were followed with imaging for 3 months with a treatment duration, mean (IQR) of 33.5 (10.8-42.5) days. Complete clot resolution was significantly higher in the anticoagulation group (48%; 17%; P = 0.03) compared with untreated patients. No group difference was noted for partial thrombus resolution (33.3%; 12.4%; P = 0.313). Anticoagulation halted thrombus progression (2.6 versus 12.4%; P = 0.025) and fewer treated patients failed to attend follow-up visits (6.5 versus 18.6%; P = 0.022). Well designed, multicenter prospective studies with larger sample sizes are required to confirm these findings.
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Affiliation(s)
- Bosco Paes
- Division of Neonatology, Department of Pediatrics
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital
| | | | - Dhiman Patel
- Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital
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12
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Bersani I, Piersigilli F, Iacona G, Savarese I, Campi F, Dotta A, Auriti C, Di Stasio E, Garcovich M. Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis. World J Hepatol 2021; 13:1802-1815. [PMID: 34904047 PMCID: PMC8637679 DOI: 10.4254/wjh.v13.i11.1802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of umbilical venous catheters (UVCs) in the perinatal period may be associated with severe complications, including the occurrence of portal vein thrombosis (PVT).
AIM To assess the incidence of UVC-related PVT in infants with postnatal age up to three months.
METHODS A systematic and comprehensive database searching (PubMed, Cochrane Library, Scopus, Web of Science) was performed for studies from 1980 to 2020 (the search was last updated on November 28, 2020). We included in the final analyses all peer-reviewed prospective cohort studies, retrospective cohort studies and case-control studies. The reference lists of included articles were hand-searched to identify additional studies of interest. Studies were considered eligible when they included infants with postnatal age up to three months with UVC-associated PVT. Incidence estimates were pooled by using random effects meta-analyses. The quality of included studies was assessed using the Newcastle-Ottawa scale. The systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.
RESULTS Overall, 16 studies were considered eligible and included in the final analyses. The data confirmed the relevant risk of UVC-related thrombosis. The mean pooled incidence of such condition was 12%, although it varied across studies (0%-49%). In 15/16 studies (94%), diagnosis of thrombosis was made accidentally during routine screening controls, whilst in 1/16 study (6%) targeted imaging assessments were carried out in neonates with clinical concerns for a thrombus. Tip position was investigated by abdominal ultrasound (US) alone in 1/16 (6%) studies, by a combination of radiography and abdominal US in 14/16 (88%) studies and by a combination of radiography, abdominal US and echocardiography in 1/16 (6%) studies.
CONCLUSION To the best of our knowledge, this is the first systematic review specifically investigating the incidence of UVC-related PVT. The use of UVCs requires a high index of suspicion, because its use is significantly associated with PVT. Well-designed prospective studies are required to assess the optimal approach to prevent UVC-related thrombosis of the portal system.
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Affiliation(s)
- Iliana Bersani
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Fiammetta Piersigilli
- Department of Neonatology, Cliniques Universitaires Saint Luc, Universitè Catholique de Louvain, Bruxelles 1200, Belgium
| | - Giulia Iacona
- Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Immacolata Savarese
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Francesca Campi
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Andrea Dotta
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Cinzia Auriti
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Enrico Di Stasio
- Department of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Matteo Garcovich
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- CEMAD Digestive Disease Center, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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13
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A review of the role of extracellular vesicles in neonatal physiology and pathology. Pediatr Res 2021; 90:289-299. [PMID: 33184501 DOI: 10.1038/s41390-020-01240-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
Extracellular vesicles (EVs) are cell-derived membrane-bound particles, extensively investigated across many fields to improve the understanding of pathophysiological processes, as biomarkers of disease and as therapeutic targets for pharmacological intervention. We aim to describe the current knowledge of EVs detected in the body fluids of human neonates, both term and preterm, from birth to 4 weeks of age. To date, EVs have been described in several neonatal body fluids, including cerebrospinal fluid, umbilical cord blood, neonatal blood, tracheal aspirates and urine. These studies demonstrate some important roles of EVs in the neonatal population, particularly in haemostasis. Moreover, some studies have demonstrated the pathophysiological mechanisms and the identification of potential biomarkers of neonatal disease. We must continue to build on this knowledge, evaluating the role of EVs in neonatal pathology, particularly in prematurity and during the perinatal adaption period. Future studies should use larger numbers, robust EV characterisation techniques and always correlate the findings to clinical outcomes. IMPACT: This article summarises the current knowledge of the effect of EVs in neonates. It describes the potential compensatory role of EVs in neonatal haemostasis. It also describes the role of EVs as mediators of pathology and as potential biomarkers of perinatal and neonatal disease.
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14
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Li H, Sun PM, Sun HW, Cui Y. Progress in clinical diagnosis and treatment of cavernous transformation of the portal vein. Shijie Huaren Xiaohua Zazhi 2021; 29:662-669. [DOI: 10.11569/wcjd.v29.i12.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cavernous transformation of the portal vein (CTPV) refers to the compensatory neoformation of venous collaterals around the hepatic portal after the main portal vein or its branches are blocked, in order to maintain liver blood perfusion. This disease is relatively rare, and in clinical practice, its etiology, diagnosis, and treatment are not well understood. Patients with portal hypertension-related syndromes need to receive active treatment. The main goal of treatment is to prevent upper gastrointestinal hemorrhage and hypersplenism caused by portal hypertension, and to restore hepatopetal portal blood perfusion. It is necessary to fully assess the patient's condition and understand the best indications for each treatment. On this basis, we should adopt individualized comprehensive treatment strategies. This article reviews the latest advances in the understanding of the etiology, diagnosis, classification, and treatment of CTPV.
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Affiliation(s)
- Hao Li
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Pei-Ming Sun
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Hong-Wei Sun
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Yan Cui
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
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15
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Abstract
The incidence of thrombotic disorders in neonates and children is increasing with advances in diagnostic modalities, supportive care, and management of many health conditions. The developing coagulation system, need for intensive care, including catheterization, and co-morbid conditions are responsible for the relatively high risk of thrombosis in neonates compared to older children. This review addresses the advances over the last 3 years in neonatal thrombosis, with a focus on epidemiology, cerebral sinovenous thrombosis (CSVT), renal vein thrombosis (RVT), and portal vein thrombosis (PVT). The incidence of neonatal thrombosis in the contemporary era is reported to be 6.9-15 per 1,000 neonatal intensive care unit (NICU) admissions, compared to 2.4 per 1,000 NICU admissions reported in older registry data. The majority of recently published studies are small, retrospective, and from single centers, albeit they emphasize the need for definitive data to support the efficacy and safety of anticoagulation therapy (ACT) in the management of CSVT, RVT, and PVT. We highlight two important international initiatives geared towards improving the evidence base for these conditions. The International Pediatric Thrombosis Network (IPTN) is a collaboration of 74 centers across 27 countries (as of January 2021) which has started important projects like the international neonatal RVT registry, while the International Pediatric Stroke Study (IPSS) group is in the planning stages of a randomized controlled trial to evaluate the utility of ACT in the management of neonatal CSVT.
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Affiliation(s)
- Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Anthony KC Chan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
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16
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Portal vein thrombosis and food protein-induced allergic proctocolitis in a premature newborn with hypereosinophilia: a case report. BMC Pediatr 2021; 21:49. [PMID: 33485314 PMCID: PMC7825155 DOI: 10.1186/s12887-021-02510-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
Background Peripheral blood eosinophilia is identified in numerous medical conditions associated with allergic, infectious, and inflammatory processes mostly as reactive eosinophilia with or without tissue eosinophilia. In hospitalized neonates, eosinophilia is common with an inverse relationship with gestational age and occurs solely as mild eosinophilia in the majority of cases. In the literature, eosinophilia has been proposed as a possible risk factor for venous thromboembolism. However, few reports are found on thromboembolic events including portal vein thrombosis (PVT) associated with eosinophilia in the newborn period. Neonates, particularly preterm infants, are vulnerable to thrombosis due to the immature and developing hemostatic system with little reserve capacity, which occurs as catheter-related thrombosis in most cases. Case presentation A male newborn at 34+ 5 weeks’ gestation presented with a left portal venous thrombus and hematochezia after initial cow’s milk feeding in the setting of blood hypereosinophilia for a prolonged period of time without central venous catheterization. The infant was diagnosed with PVT and food protein-induced allergic proctocolitis (FPIAP) and showed complete resolution of the conditions with expectant management with food avoidance, including the normalized eosinophil count. Conclusions Our experience suggests that in the setting of hypereosinophilia with a prolonged duration in premature neonates, FPIAP should be suspected in case of hematochezia in otherwise healthy infants, and considering the increased thrombotic risk by the hypereosinophilia and premature newborn status, evaluation for neonatal thrombosis may be needed, including PVT with the potential risk for the more serious, but uncommon, late complications encompassing portal hypertension.
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17
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D'Andrea V, Prontera G, Rubortone SA, Pezza L, Pinna G, Barone G, Pittiruti M, Vento G. Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training. Front Pediatr 2021; 9:774705. [PMID: 35174113 PMCID: PMC8841780 DOI: 10.3389/fped.2021.774705] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022] Open
Abstract
The umbilical venous catheter (UVC) is one of the most commonly used central lines in neonates. It can be easily inserted soon after birth providing stable intravenous access in infants requiring advanced resuscitation in the delivery room or needing medications, fluids, and parenteral nutrition during the 1st days of life. Resident training is crucial for UVC placement. The use of simulators allows trainees to gain practical experience and confidence in performing the procedure without risks for patients. UVCs are easy to insert, however when the procedure is performed without the use of ultrasound, there is a quite high risk, up to 40%, of non-central position. Ultrasound-guided UVC tip location is a simple and learnable technique and therefore should be widespread among all physicians. The feasibility of targeted training on the use of point-of-care ultrasound (POCUS) for UVC placement in the neonatal intensive care unit (NICU) among neonatal medical staff has been demonstrated. Conversely, UVC-related complications are very common and can sometimes be life-threatening. Despite UVCs being used by neonatologists for over 60 years, there are still no standard guidelines for assessment or monitoring of tip location, securement, management, or dwell time. This review article is an overview of the current knowledge and evidence available in the literature about UVCs. Our aim is to provide precise and updated recommendations on the use of this central line.
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Affiliation(s)
- Vito D'Andrea
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgia Prontera
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Serena Antonia Rubortone
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lucilla Pezza
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Pinna
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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18
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Duerden EG, Grunau RE, Chau V, Groenendaal F, Guo T, Chakravarty MM, Benders M, Wagenaar N, Eijsermans R, Koopman C, Synnes A, Vries LD, Miller SP. Association of early skin breaks and neonatal thalamic maturation: A modifiable risk? Neurology 2020; 95:e3420-e3427. [PMID: 33087497 DOI: 10.1212/wnl.0000000000010953] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/17/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To test the hypothesis that a strategy of prolonged arterial line (AL) and central venous line (CVL) use is associated with reduced neonatal invasive procedures and improved growth of the thalamus in extremely preterm neonates (<28 weeks' gestation). METHODS Two international cohorts of very preterm neonates (n = 143) with prolonged (≥14 days) or restricted (<14 days) use of AL/CVL were scanned serially with MRI. General linear models were used to determine the association between skin breaks and thalamic volumes, accounting for clinical confounders and site differences. Children were assessed at preschool age on standardized tests of motor and cognitive function. Outcome scores were assessed in relation to neonatal thalamic growth. RESULTS Prolonged AL/CVL use in neonates (n = 86) was associated with fewer skin breaks (median 34) during the hospital stay compared to restricted AL/CVL use (n = 57, median 91, 95% confidence interval [CI] 60.35-84.89). Neonates with prolonged AL/CVL use with fewer skin breaks had significantly larger thalamic volumes early in life compared to neonates with restricted line use (B = 121.8, p = 0.001, 95% CI 48.48-195.11). Neonatal thalamic growth predicted preschool-age cognitive (B = 0.001, 95% CI 0.0003-0.001, p = 0.002) and motor scores (B = 0.01, 95% CI 0.001-0.10, p = 0.02). Prolonged AL/CVL use was not associated with greater incidence of sepsis or multiple infections. CONCLUSIONS Prolonged AL/CVL use in preterm neonates may provide an unprecedented opportunity to reduce invasive procedures in preterm neonates. Pain reduction in very preterm neonates is associated with optimal thalamic growth and neurodevelopment.
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Affiliation(s)
- Emma G Duerden
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Ruth E Grunau
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Vann Chau
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Floris Groenendaal
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Ting Guo
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - M Mallar Chakravarty
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Manon Benders
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Nienke Wagenaar
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Rian Eijsermans
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Corine Koopman
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Anne Synnes
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Linda de Vries
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Steven P Miller
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada.
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Andresen JH, Saugstad OD. 50 Years Ago in TheJournalofPediatrics: Umbilical Catheters-Then and Now. J Pediatr 2020; 227:156. [PMID: 33228910 DOI: 10.1016/j.jpeds.2020.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ola Didrik Saugstad
- Department of Pediatric Research, University of Oslo, Oslo, Norway; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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