title: Efficacy of local instillation of recombinant tissue plasminogen activator for restoring occluded central venous catheters in neonates.
abstract: OBJECTIVE
  To evaluate the efficacy of local instillation of tissue plasminogen activator (tPA) for restoring function to occluded central venous catheters (CVCs) in the neonatal population.
  
  
  METHODS
  This was a retrospective review of patients admitted to the neonatal intensive care unit during September 2000 to April 2006 who received instillation of tPA for occluded CVCs.
  
  
  RESULTS
  Among 18 infants who received tPA for occluded CVCs, gestational age at birth was 32.5 weeks, birth weight was 1550 g, and gestational age at tPA administration was 39 weeks, with 4 neonates < or =32 weeks' gestational age at tPA administration; age at tPA use was 39 days (medians reported). Ten of 18 (55%) of CVC occlusions were successfully opened after using tPA. No bleeding complications of tPA were noted, including increased or new-onset intraventricular hemorrhage, overt bleeding, or changes in INR or partial thromboplastin time attributed to tPA use. Three patients (16.5%) had bacteremia within 7 days of tPA administration, and no catheter ruptures occurred.
  
  
  CONCLUSIONS
  Local instillation of tPA was successful in restoring function to occluded CVCs in a significant proportion of neonates, although success rates were lower than that reported in populations of older age. Despite the vulnerability of neonates to the potential complications of tPA, no major complications were detected even among premature infants.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Toronto, Ontario, Canada.
authors.forename: Hanifi
authors.initials: H
authors.lastname: Soylu
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Brandão
authors.forename: Kyong-Soon
authors.initials: KS
authors.lastname: Lee
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007322:Instillation, Drug; D007363:Intensive Care Units, Neonatal; D008297:Male; D011994:Recombinant Proteins; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator