title: Central venous thrombosis in children with intestinal failure on long-term parenteral nutrition.
abstract: OBJECTIVE
  Central venous thrombosis (CVT) is a serious complication of long-term central venous access for parenteral nutrition (PN) in children with intestinal failure (IF). We reviewed thse incidence of CVT and possible risk factors.
  
  
  METHODS
  Children with IF on home PN (2010-2014) with central venous imaging were reviewed. Patient demographics, catheter characteristics and related complications, and markers of liver function were compared between children with and without CVT. Serum thrombophilia markers were reviewed for patients with CVT.
  
  
  RESULTS
  Thirty children with central venous imaging were included. Seventeen patients had thrombosis of ≥1 central vein, and twelve had ≥2 thrombosed central veins. Patients with and without CVT had similar demographics and catheter characteristics. Patients with CVT had a significantly lower albumin level (2.76±0.38g/dL vs. 3.12±0.41g/dL, p=0.0223). The most common markers of thrombophilia in children with CVT were antithrombin, protein C and S deficiencies, and elevated factor VIII. There was a statistically significant correlation between a combined protein C and S deficiency and having >1 CVT.
  
  
  CONCLUSIONS
  Children with IF on long-term PN are at high risk for CVT potentially owing to low levels of natural anticoagulant proteins and elevated factor FVIII activity, likely a reflection of liver insufficiency and chronic inflammation.
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gonzalez-Hernandez
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Daoud
authors.affiliation: Division of Pediatric Surgery, University of Texas Southwestern/Children's Health, Dallas, TX, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Styers
authors.affiliation: Division of Pediatric Gastroenterology, University of Texas Southwestern/Children's Health, Dallas, TX, USA.
authors.forename: Janna M
authors.initials: JM
authors.lastname: Journeycake
authors.affiliation: Division of Pediatric Hematology-Oncology, University of Texas Southwestern/Children's Health, Dallas, TX, USA.
authors.forename: Nandini
authors.initials: N
authors.lastname: Channabasappa
authors.affiliation: Division of Pediatric Surgery, University of Texas Southwestern/Children's Health, Dallas, TX, USA. Electronic address: Hannah.Piper@childrens.com.
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Piper
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D016331:Parenteral Nutrition, Home / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*
keywords: Central venous catheter; Central venous thrombosis; Intestinal failure; Parenteral nutrition