Clinically symptomatic central venous catheter-related deep venous thrombosis in newborns

The objective of this study was to evaluate the incidence of clinically symptomatic central venous catheter (CVC)-related deep venous thrombosis (DVT) in newborns and small infants and to try to identify clinical and genetic risk factors for catheter-related DVT among children with thrombotic complications. CVC was inserted in 44 consecutive infants (age range 0-90 d) during the period January 1990 to December 1995 in the neonatal intensive care unit (NICU) of Kuopio University Hospital in Kuopio. The symptoms of DVT were: syndrome of superior vena cava in 2, swelling at the CVC puncture site in 6 and repeated CVC obstructions in 2. The formation of DVT was verified by venography. Children with DVT (n = 10) had 26 (10-365, in total 623) catheter days compared with 9 d (1-155, in total 591) in patients without DVT (n = 26) (p < 0.005). The median (range) number of days from catheter insertion to diagnosis of DVT was 19 (7-210). CVC had to be removed from 11 (25%) children due to various complications. There was no DVT-related mortality. A positive family history with thromboembolic episodes at a young age was found in 3 of 10 families with a child suffering CVC-related DVT. The levels of coagulation inhibitors were evaluated at the age of 9-69 mo in all 10 (23%) children with CVC-related DVT. We detected no deficiencies in protein S, protein C or antithrombin III. One child was heterozygous for the point mutation (R506Q) in the factor V gene known to cause activated protein C resistance (APCR). We conclude that newborns with CVC are at great risk of DVT and that the aetiology of DVT can rarely be identified via measurements of coagulation inhibitors.