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Iatrogenic vascular lesions in extremely low birth weight and low birth weight neonates
P Gamba1, Z Tchaprassian, F Verlato
1Department of Pediatric Surgery, University of Padua, Italy.
Insights
Extremely low birth weight (ELBW) and low birth weight (LBW) neonates have a higher risk of vascular injuries from aggressive treatments. Prompt microsurgery and medical interventions can lead to good outcomes and prevent long-term complications.
Area of Science:
- Neonatal Intensive Care
- Vascular Surgery
- Pediatric Medicine
Background:
- Aggressive treatments improve outcomes for extremely low birth weight (ELBW) and low birth weight (LBW) neonates.
- These treatments, however, increase the risk of iatrogenic lesions in this vulnerable population.
- Vascular injuries represent a significant concern in neonatal intensive care units (NICUs).
Purpose of the Study:
- To evaluate the incidence of vascular injuries in ELBW and LBW neonates.
- To compare the incidence of vascular injuries between LBW/ELBW neonates and those with higher birth weights.
- To identify the types and causes of vascular lesions in neonates.
Main Methods:
- A retrospective review of 2898 neonates admitted to the NICU from 1987 to 1994.
- Analysis of 335 LBW or ELBW neonates (11.5% of total admissions).
- Comparison with 10 neonates with vascular injuries among 2563 neonates weighing over 1500 g.
Main Results:
- Nine LBW/ELBW neonates (2.6%) experienced vascular lesions, compared to 0.3% in heavier neonates.
- Common injuries included femoral arteriovenous fistulas (n=6), limb ischemia (n=2), and a carotid lesion (n=1).
- Most injuries were associated with venipuncture (n=7) or umbilical catheterization (n=1); one carotid lesion resulted from surgical error.
Conclusions:
- LBW and ELBW neonates are at a significantly higher risk for iatrogenic vascular lesions compared to larger neonates.
- Aggressive management, including microsurgery and medical treatment, is recommended to achieve favorable results.
- Early intervention and appropriate treatment can prevent late sequelae in neonates with vascular injuries.
Purpose:
Aggressive treatment has improved the long-term outcome of extremely low birth weight (ELBW) and low birth weight (LBW) neonates, but it has also increased the risk of iatrogenic lesions. The aim of this paper is to evaluate the incidence of vascular injuries observed in the neonatal intensive care unit of our hospital.
Methods:
From 1987 to 1994, 2898 neonates were admitted to the neonatal intensive care unit; 335 of them were either LBW or ELBW (11.5%). A review of the charts of these neonates disclosed nine neonates (four male, five female) with vascular lesions (2.6%); the mean gestational age of these patients was 28.7 weeks (range, 24 to 33 weeks), the mean weight at birth was 880 g (range, 590 to 1450 g), and the mean weight at diagnosis was 1825 g (range, 1230 to 2700 g). In the same period, 10 neonates with vascular injuries were reported in the 2563 neonates who weighed more than 1500 g (0.3%). The injuries observed in LBW and ELBW group were arteriovenous fistulas (two bilateral) at the femoral level (six neonates), carotid lesion (one neonate), and limb ischemia (two neonates). Injury was associated with venipuncture in seven neonates, and with umbilical catheter in one; the case of carotid lesion was related to surgical error. No general symptoms were observed.
Results:
The carotid lesion and five arteriovenous fistulas were repaired by microsurgical techniques; one case of limb ischemia was resolved with thrombolytic drugs, whereas an amputation at the knee level was required in the other after 10 days of medical treatment. One neonate with an arteriovenous fistula was just observed according to the parents' wishes. At clinical and echo-color Doppler follow-up, seven of nine neonates had normal vascular function without sequelae.
Conclusions:
In our experience, LBW and ELBW neonates are at greater risk than older neonates of the development of iatrogenic vascular lesions. We advocate aggressive microsurgery, medical treatment, or both to obtain good results and prevent late sequelae.