177 EARLY ULTRASONOGRAPHIC DETECTION OF ATRIAL THROMBI IN NEONATES WITH CENTRAL VENOUS CATHETERS

Abstract

Central venous catheters (CVC) are often required for neonates in Neonatal Intensive Care Units (NICU) though they may be associated with a high incidence of complications. From August 1988 to the present, we have performed weekly ultrasound monitoring of the catheter, heart and large veins ol newborn infants with surgically inserted CVCs in order to detect early ultrasound signs of catheter related thrombosis. We have performed 248 ultrasound examinations in 50 newborns with birth weight ranging between 400 and 3800 grams. A total of 55 CVCs were monitored for a total of 1403 CVC days. The mean age at CVC insertion was 11±14 days with 80% of the CVCs placed before the 7th day of life. The mean duration of the CVCs was 29±29 days. CVCs were mainly used for total parenteral nutrition and infusion of medication, not for routine blood sampling or transfusion.

RESULTS: 50 of the 55 CVCs studied (90.1%) were free of signs of thrombosis. Three CVCs showed fibrin sleeves (FS) around the tip, 2 of which progressed to atrial thrombosis (AT). Four CVCs (7.3%) were associated with AT, 2 as a result of the progression of FS, and 2 in which AT was seen as primary. Two of the ATs were diagnosed within 7 days of catheter placement. Urokinase treatment (4400 IU/Kg IV bolus+ 4400 IU/Kg/h IV maintenance) led to complete resolution of the AT in all the 3 cases treated, with no side effects.

CONCLUSIONS: 1) Weekly ultrasound monitoring of CVCs in newborns showed 7.2% to have asymtomatic AT. 2) Urokinase prompty resolved AT in the 3 treated cases without the need of CVC removal. 3) FS could be an early sign of AT and must be closely monotored. Further data are needed to verify if FS shoud be treated before AT develops.

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