Clinically symptomatic central venous catheter-related deep venous thrombosis in newborns.
The objective of this study was to evaluate the incidence of clinically symptomatic central venous catheter (CVC)-related deep venous thrombosis (DVT) in newborns and small infants and to try to identify clinical and genetic risk factors for catheter-related DVT among children with thrombotic complications. CVC was inserted in 44 consecutive infants (age range 0-90 d) during the period January 1990 to December 1995 in the neonatal intensive care unit (NICU) of Kuopio University Hospital in Kuopio. The symptoms of DVT were: syndrome of superior vena cava in 2, swelling at the CVC puncture site in 6 and repeated CVC obstructions in 2. The formation of DVT was verified by venography. Children with DVT (n = 10) had 26 (10-365, in total 623) catheter days compared with 9 d (1-155, in total 591) in patients without DVT (n = 26) (p < 0.005). The median (range) number of days from catheter insertion to diagnosis of DVT was 19 (7-210). CVC had to be removed from 11 (25%) children due to various complications. There was no DVT-related mortality. A positive family history with thromboembolic episodes at a young age was found in 3 of 10 families with a child suffering CVC-related DVT. The levels of coagulation inhibitors were evaluated at the age of 9-69 mo in all 10 (23%) children with CVC-related DVT. We detected no deficiencies in protein S, protein C or antithrombin III. One child was heterozygous for the point mutation (R506Q) in the factor V gene known to cause activated protein C resistance (APCR). We conclude that newborns with CVC are at great risk of DVT and that the aetiology of DVT can rarely be identified via measurements of coagulation inhibitors.
Salonvaara
M
M
Department of Pediatrics, Kuopio University Hospital, Finland.
Riikonen
P
P
Kekomäki
R
R
Heinonen
K
K
D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000235:genetics; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005165:Factor V / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017354:Point Mutation / Q000235:genetics; D011486:Protein C / Q000502:physiology; D017293:Protein S / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000209:etiology* / Q000235:genetics
D011486:Protein C; D017293:Protein S; D005165:Factor V