Is longer indwelling duration an independent risk factor for UVC-related thrombosis? Insights from a matched...

Umbilical venous catheter (UVC)-associated thrombosis is a major complication in the neonatal intensive care unit (NICU). Whether longer catheter dwell time independently increases this risk remains highly debated. This study aimed to isolate and evaluate specific risk factors for UVC-related thrombosis using a rigorous matched case-control design to control for baseline developmental confounders.

We conducted a retrospective, 1:2 matched case-control study. Neonates with ultrasound-confirmed UVC-related thrombosis were matched with controls based on gestational age and birth weight. Clinical characteristics, UVC indwelling duration, and laboratory biomarkers (including D-Dimer) were compared between the two cohorts. Receiver Operating Characteristic (ROC) curve analysis was utilized to evaluate the predictive utility of these variables.

The study included 34 cases and 68 matched controls. Baseline demographics, including gestational age and birth weight, were successfully balanced between groups (all P > 0.05). The median UVC indwelling duration was identical in both the thrombosis and control cohorts (8.0 vs. 8.0 days, P = 0.206). Although D-Dimer levels exhibited greater variance in the thrombosis group, the median difference was not statistically significant (P = 0.808). Furthermore, ROC analysis demonstrated poor predictive value for both indwelling duration (AUC = 0.42) and D-Dimer levels (AUC = 0.55).

When crucial baseline confounders are strictly controlled, longer UVC indwelling duration does not emerge as an independent risk factor for thrombosis. Clinical management should prioritize correct catheter tip positioning and standardized maintenance protocols rather than adhering to rigid, arbitrary removal timelines. Additionally, D-Dimer levels lack reliability as a standalone predictive biomarker in this specific neonatal population.