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Early intracardiac thrombosis in preterm infants and thrombolysis with recombinant tissue type plasminogen activator
F Ferrari1, F Vagnarelli, G Gargano
1Department of Paediatrics, Division of Neonatology, Modena University Hospital, Via del Pozzo, 41100 Modena, Italy. Ferrarif@unimo.it
Insights
Catheter-related thrombosis occurs in 5% of preterm infants. Recombinant tissue plasminogen activator (rt-PA) effectively and safely dissolves these clots, allowing for rapid treatment.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Hematology
Background:
- Umbilical catheters are essential for preterm infant care.
- Catheter-related thrombosis is a potential complication.
- Early detection and treatment are crucial.
Purpose of the Study:
- To determine the incidence of catheter-related thrombosis in very low birthweight infants.
- To evaluate the efficacy of recombinant tissue type plasminogen activator (rt-PA) for treating intracardiac thrombosis.
- To assess the safety of rt-PA in this population.
Main Methods:
- Echocardiography was performed on 76 very low birthweight infants with umbilical catheters.
- Intracardiac thrombosis was diagnosed via echocardiography.
- rt-PA was administered for thrombus lysis.
Main Results:
- Four infants (5%) developed intracardiac thrombosis.
- rt-PA successfully dissolved clots in three infants with a bolus dose.
- One infant required a prolonged infusion after the bolus, achieving resolution.
- No systemic adverse effects were observed with rt-PA treatment.
Conclusions:
- Early thrombosis is a complication of umbilical catheterization in preterm infants.
- Echocardiography enables early diagnosis of catheter-related thrombosis.
- rt-PA provides a safe and effective treatment for rapid clot lysis.
Objectives:
To determine the incidence of catheter related thrombosis and to test the efficacy of recombinant tissue type plasminogen activator (rt-PA) in preterm infants.
Study Design:
From January 1995 to December 1998, echocardiography was performed in the first few days of life in 76 very low birthweight (< or = 1500 g) infants out of a total of 147 having an umbilical catheter placed. When intracardiac thrombosis was diagnosed, rt-PA infusion was performed.
Results:
Four infants (5%) developed an intracardiac thrombosis during the first few days of life. In three of them, rt-PA at a dose of 0.4-0.5 mg/kg in a 20-30 minute bolus led to dissolution of the clot. One patient received a three hour infusion after the bolus, at a dose of 0.1 mg/kg/h, with resolution of the thrombus. No systemic effects were observed after rt-PA infusion.
Conclusions:
Early thrombosis may occur as a complication of umbilical catheterisation in preterm infants; early echocardiographic detection of this disorder allows complete, safe, and rapid lysis with rt-PA.