title: Risk factors for hospital-sssociated venous thromboembolism in the neonatal intensive care unit.
abstract: OBJECTIVE
  To determine hospital-associated venous thromboembolism (HA-VTE) risk factors in critically ill neonates.
  
  
  METHODS
  We conducted a case-control study in the neonatal intensive care unit (NICU) of All Children's Hospital Johns Hopkins Medicine (St. Petersburg, FL), from January 1, 2006 - April 10, 2013. We identified HA-VTE cases using electronic health record. Four NICU controls were randomly selected for each HA-VTE case. Associations between putative risk factors and HA-VTE were estimated using odds ratios (ORs) and ninety-five percent confidence intervals (95%CIs) from univariate and multivariate regression analyses.
  
  
  RESULTS
  Twenty-three HA-VTE cases and 92 controls were included. The annual HA-VTE incidence was approximately 1.4 HA-VTE cases per 1,000 NICU admissions. In univariate analyses, mechanical ventilation (OR=7.27, 95%CI=2.02-26.17, P=0.002), central venous catheter (CVC; OR=52.95, 95%CI=6.80-412.71, P<0.001), infection (OR=7.24, 95%CI=2.66-19.72, P<0.001), major surgery (OR=5.60, 95%CI=1.82-17.22, P=0.003) and length of stay ≥15days (OR=6.67, 95%CI=1.85-23.99, P=0.004) were associated with HA-VTE. Only CVC (OR=29.04, 95%CI=3.18-265.26, P=0.003) remained an independent risk factor in the multivariate analysis. Based on this result, the estimated risk of HA-VTE in NICU patients with a CVC was 0.9%.
  
  
  CONCLUSIONS
  This study identifies CVC as an independent risk factor for HA-VTE in critically ill neonates. However, the level of risk associated with CVC is below the conventional threshold for primary anticoagulation thromboprophylaxis. Larger studies are needed to substantiate these findings and identify novel putative risk factors to further distinguish NICU patients at highest HA-VTE risk.
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA.
authors: Ernest K
authors: EK
authors: Amankwah
authors: Undergraduate Medical Education, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors: Christie M
authors: CM
authors: Atchison
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA.
authors: Shilpa
authors: S
authors: Arlikar
authors: Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD, USA.
authors: Irmel
authors: I
authors: Ayala
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD, USA.
authors: Laurie
authors: L
authors: Barrett
authors: Section of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, University of Colorado School of Medicine Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.
authors: Brian R
authors: BR
authors: Branchford
authors: Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Michael
authors: M
authors: Streiff
authors: Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD, USA; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Clifford
authors: C
authors: Takemoto
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD, USA; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: neil.goldenberg@allkids.org.
authors: Neil A
authors: NA
authors: Goldenberg
mesh_terms: D016022:Case-Control Studies; D062905:Central Venous Catheters / Q000009:adverse effects; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000150:complications; D007363:Intensive Care Units, Neonatal; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology*
keywords: neonates; risk factor; thrombosis; venous thromboembolism