Faculty Collaboration Database

Risk factors for hospital-sssociated venous thromboembolism in the neonatal intensive care unit. Thromb Res 2014 Aug;134(2):305-9

Date

06/24/2014

Pubmed ID

24953982

Pubmed Central ID

PMC7269108

DOI

10.1016/j.thromres.2014.05.036

Scopus ID

2-s2.0-84905101043 (requires institutional sign-in at Scopus site)   61 Citations

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%.

CONCLUSION: 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.

Author List

Amankwah EK, Atchison CM, Arlikar S, Ayala I, Barrett L, Branchford BR, Streiff M, Takemoto C, Goldenberg NA

Authors

Ernest Amankwah PhD Director, Associate Professor in the Clinical and Translational Science Institute department at Medical College of Wisconsin
Brian Branchford MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Case-Control Studies
Central Venous Catheters
Critical Illness
Female
Humans
Incidence
Infant
Infant, Newborn
Intensive Care Units, Neonatal
Male
Odds Ratio
Postoperative Complications
Respiration, Artificial
Risk Factors
Venous Thromboembolism