Management of major thromboembolic complications of umbilical artery catheters

doi:10.1016/S0022-3468(81)80858-5

Journal of Pediatric Surgery

Volume 16, Issue 6, December 1981, Pages 972-978

https://doi.org/10.1016/S0022-3468(81)80858-5 Get rights and content

Over the last 9 yr approximately 4000 infants have had physiologic monitoring with UAC at Vanderbilt University Medical Center. A large number of them had minor ischemic complications prompting removal of the catheter, but 41 patients had major thromboembolic problems requiring varying degrees of surgical management. The place of surgery is clear in patients with catheter emboli or bleeding due to vascular avulsion related to catheter removal. Patients with arterial occlusion distal to the femoral artery may be treated expectantly although significant skin loss may occur. Occlusions at the femoral level allow limb survival, but the long-term outlook is not known; perhaps these patients may better be subjected to femoral thrombectomy in the future. Peripheral pulses are not normal early and Doppler studies suggest that collateral circulation is responsible for limb survival. Whether this will be sufficient to support adequate limb growth and function remains to be seen. Patients with signs of aortoiliac or mesenteric occlusion should be rapidly investigated and operated upon if survival is to be obtained. This study suggests that an aggressive surgical approach is in order. Computer-assisted radionuclide flow studies are helpful in diagnosing major aortic occlusion, as well as for followup.

References (16)

KraussAN et al.
Contamination of umbilical catheters in the newborn infant
J Pediatr
(1970)
AzizEM et al.
Paraplegia: A complication of umbilical artery catheterization
J Pediatr
(1973)
PlumerLB et al.
Hypertension in infants: A complication of umbilical artery catheterization
J Pediatr
(1976)
MillerD et al.
Pelvic exsanguination following umbilical artery catheterization in neonates
J Pediatr Surg
(1979)
WiggerHJ et al.
Thromboses due to catheterization in infants and children
J Pediatr
(1970)
NelsonNM et al.
Pulmonary function in the newborn infant
Pediatrics
(1962)
LackeyDA et al.
An unusual complication of umbilical artery catheterization
Pediatrics
(1972)
JoshiVV et al.
Neonatal necrotizing enterocolitis: Occurrence secondary to thrombosis of abdominal aorta following umbilical artery catheterization
Arch Pathol
(1975)

There are more references available in the full text version of this article.

Cited by (78)

Spontaneous neonatal arterial thrombosis: A report of 4 neonates
2012, Archives de Pediatrie
Les thromboses artérielles sont rares chez le nouveau-né. Elles sont le plus souvent liées à l’utilisation des cathéters vasculaires. En dehors de ce contexte, elles sont encore beaucoup plus rares. Il nous a semblé intéressant à propos de thromboses artérielles, survenues spontanément chez 4 nouveau-nés, de faire une mise à jour étiologique et thérapeutique sur cette affection dont la faible incidence rend la prise en charge difficile et encore controversée. Le diagnostic de thrombose artérielle était évident devant des signes d’ischémie à l’examen clinique chez 2 nouveau-nés, atteints de thrombose des artères iliaques. Il était moins évident devant une anurie associée à une hypertension artérielle chez 2 nouveau-nés atteints de thrombose de l’aorte abdominale et une anurie avec maelena chez 1 nouveau-né atteint de thrombose aortique et mésentérique. Le diagnostic avait été confirmé par l’échographie doppler chez 3 d’entre eux et sur les données de l’autopsie chez l’autre. Un retard de consultation avait été noté chez 3 nouveau-nés, dont l’issue avait été fatale. L’évolution avait été favorable après thrombolyse et héparinothérapie dans un cas de thrombose aortique majeure.
Arterial thromboses are rare in newborns, mostly caused by arterial catheters. Neonatal arterial thrombosis occurring in other contexts is much rare. We report arterial thrombosis, not caused by catheterisation in 4 neonates hospitalised in the neonatology department of the Farhat Hached de Sousse hospital in Tunisia. The diagnosis of arterial thrombosis was made based on signs of ischemia in 2 patients affected by thrombosis of the iliac arteries. The symptoms were less clear: anuria associated with arterial high blood pressure in 1 patient affected by thrombosis of the abdominal aorta and by anuria with melena in a newborn with aortic and mesenteric thrombosis. Diagnosis was confirmed by Doppler sonography in 3 patients and based on autopsy data in 1 patient. A delay to consultation was noted in 3 patients, whose outcome was fatal. The progression was favourable after thrombolysis and anticoagulation using heparin in 1 patient with major aortic thrombosis. A review of the literature on the epidemiological, clinical, therapeutic and outcome data of the arterial thrombosis in the newborn child is provided.
Pediatric Arterial Diseases
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and Print
Vascular Injury
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and Print
Antithrombotic therapy in neonates and children: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines
2012, Chest
Citation Excerpt :
For neonates and children with a symptomatic peripheral arterial catheter-related TE, we suggest UFH anticoagulation with or without thrombolysis or surgical thrombectomy and microvascular repair with subsequent heparin therapy (Grade 2C). The incidence of symptomatic thrombosis of umbilical arterial catheters (UACs) is 1% to 3%,330–332 with studies using sequential imaging and autopsy data reporting a higher incidence.333,334 Factors increasing risk include longer catheter duration333 and the positioning of the UAC tip, which are routinely described as high or low.
Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. This guideline addresses optimal strategies for the management of thrombosis in neonates and children.
The methods of this guideline follow those described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
We suggest that where possible, pediatric hematologists with experience in thromboembolism manage pediatric patients with thromboembolism (Grade 2C). When this is not possible, we suggest a combination of a neonatologist/pediatrician and adult hematologist supported by consultation with an experienced pediatric hematologist (Grade 2C). We suggest that therapeutic unfractionated heparin in children is titrated to achieve a target anti-Xa range of 0.35 to 0.7 units/mL or an activated partial thromboplastin time range that correlates to this anti-Xa range or to a protamine titration range of 0.2 to 0.4 units/mL (Grade 2C). For neonates and children receiving either daily or bid therapeutic low-molecular-weight heparin, we suggest that the drug be monitored to a target range of 0.5 to 1.0 units/mL in a sample taken 4 to 6 h after subcutaneous injection or, alternatively, 0.5 to 0.8 units/mL in a sample taken 2 to 6 h after subcutaneous injection (Grade 2C).
The evidence supporting most recommendations for antithrombotic therapy in neonates and children remains weak. Studies addressing appropriate drug target ranges and monitoring requirements are urgently required in addition to site- and clinical situation-specific thrombosis management strategies.
Vascular Injury
2012, Pediatric Surgery
Pediatric Arterial Diseases
2012, Pediatric Surgery

View all citing articles on Scopus

^*: Presented before The Twelfth Annual Meeting of the American Pediatric Surgical Association together with the British Association of Paediatric Surgeons, Tarpon Springs, Florida, April 29–May 2, 1981.

¹: From the Departments of Pediatric Surgery and Radiology, Vanderbilt University Medical Center, Nashville, Tenn.

View full text

Management of major thromboembolic complications of umbilical artery catheters*

J Pediatr

J Pediatr

J Pediatr

J Pediatr Surg

J Pediatr

Pulmonary function in the newborn infant

Pediatrics

An unusual complication of umbilical artery catheterization

Pediatrics

Neonatal necrotizing enterocolitis: Occurrence secondary to thrombosis of abdominal aorta following umbilical artery catheterization

Arch Pathol