In a study, researchers identified risk factors for venous and arterial thrombosis in neonatal patients admitted to neonatal intensive care units (NICUs) throughout the US. The study’s findings were reported in the journal Lancet Haematology.
This case-control analysis included neonates treated at any of 31 level IV NICUs in the US, with data derived from the Children’s Hospital Neonatal Database for patients treated during the years of 2010 through 2016. Cases that were evaluated in this study involved patients who were found to have venous or arterial thrombosis. Each patient case was matched with 4 randomly selected control individuals, with matching based on gestational age, hospital, admission year, and presence of a central access device (CAD).
A total of 118,952 new NICU admissions were identified, among which 1326 cases of thrombosis were found that met eligibility criteria, and 5304 control individuals were included in the analysis. The overall incidence of thrombosis in this study was 15.5 per 1000 NICU admissions (95% CI, 14.8-16.2). Venous thrombosis occurred with an incidence of 11.5 per 1000 admissions (95% CI, 10.9-12.1), while arterial thrombosis was found to have an incidence of 4.8 per 1000 admissions (95% CI, 4.4-5.2).
In a multivariate logistic regression analysis, several risk factors were found to be significantly, independently associated with either venous and/or arterial thrombosis. For venous thrombosis, these included thrombocytopenia (odds ratio [OR] 2.44; 95% CI, 2.02-2.94), bloodstream infection (OR, 2.07; 95% CI, 1.72-2.49) maternal diabetes (OR, 1.62; 95% CI, 1.30-2.03), an age of 7 days or older at admission (OR, 1.49; 95% CI, 1.28-1.74), abdominal/gastrointestinal surgery (OR, 1.36; 95% CI, 1.17-1.58), and prolonged mechanical ventilation (OR, 1.27; 95% CI, 1.10-1.46).
Arterial thrombosis was significantly associated with some of the same risk factors as seen with venous thrombosis, but with some differences. For arterial thrombosis, independent risk factors included thrombocytopenia (OR, 2.20; 95% CI, 1.59-3.06), prolonged mechanical ventilation (OR, 1.58; 95% CI, 1.24-2.01), small size for gestational age (OR, 1.56; 95% CI, 1.13-2.16), maternal hypertension (OR, 1.42; 95% CI, 1.05-1.91), and an age of 7 days or older at admission (OR, 1.35; 95% CI, 1.05-1.74).
The study results suggested bloodstream infection, maternal diabetes, and abdominal or gastrointestinal surgery may be specific risk factors for venous thrombosis, while maternal hypertension and small size for gestational age appeared to be specific risk factors for arterial thrombosis. In an analysis of patients with CADs, both venous and arterial thrombosis were associated with factors such as the presence of CAD in both the upper and lower body, and a CAD duration of 21 or more days.
“Although some of the risk factors are not modifiable, our data can help inform process improvement initiatives focused on prevention, treatment, and reducing costs associated with neonatal thrombosis at the hospital, regional, or national level,” the researchers concluded in their report.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Bhat R, Kwon S, Zaniletti I, Murthy K, Liem RI. Risk factors associated with venous and arterial neonatal thrombosis in the intensive care unit: a multicentre case-control study. Lancet Haematol. 2022;9(3):e200-e207. doi:10.1016/S2352-3026(21)00399-9