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Central Vascular Thrombosis in Neonates with Congenital Heart Disease Awaiting Cardiac Intervention

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Abstract

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.

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Abbreviations

CHD:

Congenital heart disease

CHS:

Congenital cardiac surgery

NICU:

Neonatal intensive care unit

CVC:

Central vascular catheter

CVT:

Central vascular thrombosis

ECLS:

Extracorporeal life support

EMR:

Electronic medical records

SNAPPE-II:

The score for neonatal acute physiology with perinatal extension- II

UAC:

Umbilical arterial catheter

UVC:

Umbilical venous catheter

PICC:

Peripherally inserted central catheter

r-tPA:

Recombinant tissue plasminogen activator

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Funding

Limited funding was made available by the Department of Pediatrics and the Division of Pediatric and Congenital Heart surgery at Augusta University Medical Center. The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Augusta University, Augusta, GA, USA

    Alexander J. Eason & Brian K. Stansfield

  2. Division of Pediatric and Congenital Heart Surgery, Department of Surgery, Augusta University, Augusta, GA, USA

    Danielle Crethers & Anastasios C. Polimenakos

  3. Division of Biostatistics and Data Science, Department of Population Health, Augusta University, Augusta, GA, USA

    Santu Ghosh

  4. Medical College of Georgia, Congenital and Pediatric Cardiothoracic Surgery, Children’s Hospital of Georgia, 1120 15th Street BAA 8222, Augusta, GA, 30912, USA

    Anastasios C. Polimenakos

Authors
  1. Alexander J. Eason
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  2. Danielle Crethers
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  3. Santu Ghosh
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  4. Brian K. Stansfield
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  5. Anastasios C. Polimenakos
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Correspondence to Anastasios C. Polimenakos.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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The study was approved by the Institutional Review Board. Need for parental consent was waived.

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Eason, A.J., Crethers, D., Ghosh, S. et al. Central Vascular Thrombosis in Neonates with Congenital Heart Disease Awaiting Cardiac Intervention. Pediatr Cardiol 41, 1340–1345 (2020). https://doi.org/10.1007/s00246-020-02383-2

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  • DOI: https://doi.org/10.1007/s00246-020-02383-2

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