Risk Factors for Neonatal Venous and Arterial Thromboembolism in the Neonatal Intensive Care Unit—A Case Control Study

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Abstract

Objective: To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit. Study design: A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately. Results: The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75% vs 49%; P <.01) were of extremely preterm gestational age (22-27 weeks; 26% vs 15.0%; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53% vs 32.9%; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95% CI, 1.03-4.35; P =.04) and blood stream infection (AOR, 3.47; 95% CI, 1.30-9.24; P =.01). Conclusions: The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.

Original languageEnglish (US)
Pages (from-to)28-32
Number of pages5
JournalJournal of Pediatrics
Volume195
DOIs
StatePublished - Apr 1 2018

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Neonatal Intensive Care
Venous Thromboembolism
Case-Control Studies
Thrombosis
Venous Thrombosis
Neonatal Intensive Care Units
Newborn Infant
Gestational Age
Vascular Access Devices
Logistic Models
Incidence
Infection
Regression Analysis
Databases
Equipment and Supplies
Population

Keywords

  • central access devices
  • maternal and neonatal risk factors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{e10b3471df024bf8850e4078551ee2da,
title = "Risk Factors for Neonatal Venous and Arterial Thromboembolism in the Neonatal Intensive Care Unit—A Case Control Study",
abstract = "Objective: To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit. Study design: A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately. Results: The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75{\%} vs 49{\%}; P <.01) were of extremely preterm gestational age (22-27 weeks; 26{\%} vs 15.0{\%}; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53{\%} vs 32.9{\%}; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95{\%} CI, 1.03-4.35; P =.04) and blood stream infection (AOR, 3.47; 95{\%} CI, 1.30-9.24; P =.01). Conclusions: The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.",
keywords = "central access devices, maternal and neonatal risk factors",
author = "Rukhmi Bhat and Riten Kumar and Soyang Kwon and Karna Murthy and Liem, {Robert I}",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.jpeds.2017.12.015",
language = "English (US)",
volume = "195",
pages = "28--32",
journal = "Journal of Pediatrics",
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TY - JOUR

T1 - Risk Factors for Neonatal Venous and Arterial Thromboembolism in the Neonatal Intensive Care Unit—A Case Control Study

AU - Bhat, Rukhmi

AU - Kumar, Riten

AU - Kwon, Soyang

AU - Murthy, Karna

AU - Liem, Robert I

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objective: To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit. Study design: A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately. Results: The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75% vs 49%; P <.01) were of extremely preterm gestational age (22-27 weeks; 26% vs 15.0%; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53% vs 32.9%; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95% CI, 1.03-4.35; P =.04) and blood stream infection (AOR, 3.47; 95% CI, 1.30-9.24; P =.01). Conclusions: The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.

AB - Objective: To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit. Study design: A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately. Results: The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75% vs 49%; P <.01) were of extremely preterm gestational age (22-27 weeks; 26% vs 15.0%; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53% vs 32.9%; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95% CI, 1.03-4.35; P =.04) and blood stream infection (AOR, 3.47; 95% CI, 1.30-9.24; P =.01). Conclusions: The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.

KW - central access devices

KW - maternal and neonatal risk factors

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U2 - 10.1016/j.jpeds.2017.12.015

DO - 10.1016/j.jpeds.2017.12.015

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VL - 195

SP - 28

EP - 32

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

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