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Central Vascular Thrombosis in Neonates with Congenital Heart Disease Awaiting Cardiac Intervention.
Pediatric Cardiology ( IF 1.5 ) Pub Date : 2020-05-29 , DOI: 10.1007/s00246-020-02383-2
Alexander J Eason 1 , Danielle Crethers 2 , Santu Ghosh 3 , Brian K Stansfield 1 , Anastasios C Polimenakos 2, 4
Affiliation  

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.



中文翻译:

有心脏介入的先天性心脏病新生儿的中央血管血栓形成。

重症新生儿的中央血管血栓形成(CVT)具有重要的临床意义。等待心脏介入治疗的先天性心脏病(CHD)新生儿可能与血栓形成的风险增加有关。进行结果分析。分析了2015年1月至2016年12月在心脏介入治疗前入院重症监护室的77例冠心病新生儿。排除需要任何心脏干预之前需要体外生命支持或接受与中心血管导管(CVC)不相关的预防性抗凝的患者。CVT的诊断基于临床指征,并经影像学证实可进行抗凝治疗。评估了CVC的位置和CVT的程度以及治疗,结局,血管通路的类型和持续时间。逻辑回归多元分析用于评估结果的预测因子。患有冠心病的新生儿并发CVT的比例为10.4%。在患有冠心病的新生儿中,较长的CVC持续时间也与血栓形成有关(72.7天比29.3天,p  <  0.001)。结果的独立预测因素包括较低的胎龄和冠心病伴单心室(SV)解剖(p  <0.05)。在等待心脏介入治疗的冠心病新生儿中,CVT的风险很高。持续时间CVC,较低的胎龄和SV解剖是结局的风险决定因素。针对新生儿的这一独特子集而量身定制的监视协议的标准化开发以及对质量准则的遵守会影响结果。

更新日期:2020-05-29
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