Review of interventional procedures in the very low birth-weight infant (<1.5 kg): complications, lessons learned and current practice.
BACKGROUND
Interventional radiology (IR) procedures in very low birth-weight (VLBW) infants (<1.5 kg) are challenging due to size, immaturity, comorbidities and lack of devices of suitable size. Infants are moved from the neonatal intensive care unit to the IR suite, further exposing them to risk. Our purpose was to review our experience of interventional procedures in VLBW infants, specifically complications and potential risks.


METHODS
VLBW infants referred for image-guided therapy between 1998 and 2005 were identified and medical records reviewed. "Complications" were divided into: major or minor, periprocedural or postprocedural, and intervention-/device-related, patient-related or equipment-related. Transport risk index of physiological stability (TRIPS) scores were calculated.


RESULTS
A total of 116 infants (68 male, 48 female) underwent 176 procedures (159 vascular access-related and 17 nonvascular). Of 158 complications identified, 116 were major and 42 were minor. Major complications included hypothermia (n=33), line manipulations/removals (n=25), bleeding (n=12), thrombosis (n=4), cardiac arrest (n=3), tamponade (n=2), and multiorgan failure (n=1). Of the complications, 119 were categorized as intervention-/device-related, 32 patient-related and 7 equipment-related. There were no significant differences between pre- and postprocedural TRIPS scores.


CONCLUSIONS
Successful completion of IR procedures in the VLBW infant is possible, but complications still occur in these fragile infants.
Department of Diagnostic Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
Eoghan E
EE
Laffan
Patrick J
PJ
McNamara
Joao
J
Amaral
Hilary
H
Whyte
Johanne
J
L'Herault
Michael
M
Temple
Philip
P
John
Bairbre L
BL
Connolly
D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015642:Radiology, Interventional / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate