Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Introduction: Central venous catheters are important tools used in critically ill neonates but related complications such as infection, occlusion and thrombosis must be taken in consideration. Objective : The present study was conducted to evaluate the outcome for neonatal CVC-thrombosis and evaluate its prevalence in our center. Patients and methods: This was a cross-sectional observational study conducted in the Neonatal Intensive Care units (NICUs) for 180 neonates who needed CVCs. 30 neonates from the 180 enrolled developed catheter thrombosis, related history, examination, and catheter information were recruited from files during the time period of one year from July 2018 to July 2019. Results: 20 (66.7%) cases with inserted CVL were due to failure of cannulation and 10 (33.3%) patients with inserted CVL for parenteral nutrition. Most of the inserted central catheters were ultrasound guided (83.3%) and 76.7% were by pediatric surgery resident.The majority (46.7%) were inserted from the first attempt and 40% of patients had a chest X-ray done immediately after line insertion to confirm position. The CVL tip was located at the SVC in 50% of cases. Main signs of thrombosis were sepsis, face and neck edema and thrombocytopenia. Average thrombus size was 2{u00D7}2 mm. 26.7% of the included neonates died, two (6.7%) of them died because of thrombocytopenia and intracranial hemorrhage (ICH) as a complication of treatment. Birth weight was significantly lower among patients with high-risk thrombi with p-value=0.040. Superior Vena Cava (SVC) was the commonest site of thrombosis in neonates with low risk thrombus while right internal jugular vein (Rt.IJV) was the most common site of thrombosis in neonates with high risk thrombus. Platelet count was significantly lower after catheter insertion while INR was significantly higher after catheter insertion. The present study revealed statistically significant correlation of upper limb edema and Doppler findings with P-value = .002

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