title: Risk Factors for Intracardiac Thrombosis in the Right Atrium and Superior Vena Cava in Critically Ill Neonates who Required the Installation of a Central Venous Catheter.
abstract: Central venous catheter (CVC) installation is essential for the treatment of critically ill neonates; however, it is associated with the development of neonatal intracardiac thrombosis, which is a complication that is associated with a poor prognosis. We aimed to identify specific risk factors for the development of intracardiac thrombosis in the right atrium (RA) and superior vena cava (SVC) related to the use of CVC in critically ill neonates.
  
  
  
  A case-control study was conducted at the tertiary referral neonatal intensive care unit of the Pediatric Hospital Siglo XXI in Mexico City, Mexico from 2008 to 2013. The included cases (n = 43) were de novo patients with intracardiac thrombosis in the RA and SVC diagnosed by echocardiography. The controls (n = 43) were neonates without intracardiac thrombosis or thrombosis at other sites. A logistic regression analysis was conducted, and odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.
  
  
  
  The independent risk factors for intracardiac thrombosis in the RA and SVC were the surgical cut-down insertion technique (OR = 2.98; 95% CI: 1.18-9.10), a maternal history of gestational diabetes/diabetes mellitus (OR = 10.64; 95% CI: 1.13-121.41), Staphylococcus epidermidis infection (OR = 7.09; 95% CI: 1.09-45.92), and CVC placement in the SVC (OR = 5.77; 95% CI: 1.10-30.18).
  
  
  
  This study allowed us to identify several contributing factors to the development of intracardiac thrombosis in the RA and SVC related to the installation of a CVC in a subgroup of critically ill neonates. Multicenter and well-designed studies with a larger number of patients could help validate our findings and/or identify other risk factors that were not identified in the present study.
authors.affiliation: Neonatal Intensive Care Unit, Pediatric Hospital, The Siglo XXI National Medical Center Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ulloa-Ricardez
authors.affiliation: Neonatal Intensive Care Unit, Pediatric Hospital, The Siglo XXI National Medical Center Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico.
authors.forename: Lizett
authors.initials: L
authors.lastname: Romero-Espinoza
authors.affiliation: Department of Pediatric Cardiology, Pediatric Hospital, The Siglo XXI National Medical Center, Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico.
authors.forename: María de Jesús
authors.initials: Mde J
authors.lastname: Estrada-Loza
authors.affiliation: Neonatal Intensive Care Unit, Pediatric Hospital, The Siglo XXI National Medical Center Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico.
authors.forename: Héctor Jaime
authors.initials: HJ
authors.lastname: González-Cabello
authors.affiliation: Research Unit in Clinical Epidemiology, Pediatric Hospital, The Siglo XXI National Medical Center, Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico. Electronic address: jcarlos_nu@hotmail.com.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Núñez-Enríquez
mesh_terms: D016022:Case-Control Studies; D002405:Catheterization, Central Venous; D062905:Central Venous Catheters; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000209:etiology*; D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D006325:Heart Atria; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D014683:Vena Cava, Superior
keywords: coagulation; intracardiac thrombosis; neonates; risk factors