Risk factors for hospital-sssociated venous thromboembolism in the neonatal intensive care unit

Ernest K. Amankwah, Christie M. Atchison, Shilpa Arlikar, Irmel Ayala, Laurie Barrett, Brian R. Branchford, Michael Streiff, Clifford Takemoto, Neil A. Goldenberg

Research output: Contribution to journalArticle

Abstract

Objective To determine hospital-associated venous thromboembolism (HA-VTE) risk factors in critically ill neonates. Methods We conducted a case-control study in the neonatal intensive care unit (NICU) of All Children's Hospital Johns Hopkins Medicine (St. Petersburg, FL), from January 1, 2006 - April 10, 2013. We identified HA-VTE cases using electronic health record. Four NICU controls were randomly selected for each HA-VTE case. Associations between putative risk factors and HA-VTE were estimated using odds ratios (ORs) and ninety-five percent confidence intervals (95%CIs) from univariate and multivariate regression analyses. Results Twenty-three HA-VTE cases and 92 controls were included. The annual HA-VTE incidence was approximately 1.4 HA-VTE cases per 1,000 NICU admissions. In univariate analyses, mechanical ventilation (OR = 7.27, 95%CI = 2.02-26.17, P = 0.002), central venous catheter (CVC; OR = 52.95, 95%CI = 6.80-412.71, P < 0.001), infection (OR = 7.24, 95%CI = 2.66-19.72, P < 0.001), major surgery (OR = 5.60, 95%CI = 1.82-17.22, P = 0.003) and length of stay ≥ 15 days (OR = 6.67, 95%CI = 1.85-23.99, P = 0.004) were associated with HA-VTE. Only CVC (OR = 29.04, 95%CI = 3.18-265.26, P = 0.003) remained an independent risk factor in the multivariate analysis. Based on this result, the estimated risk of HA-VTE in NICU patients with a CVC was 0.9%. Conclusion This study identifies CVC as an independent risk factor for HA-VTE in critically ill neonates. However, the level of risk associated with CVC is below the conventional threshold for primary anticoagulation thromboprophylaxis. Larger studies are needed to substantiate these findings and identify novel putative risk factors to further distinguish NICU patients at highest HA-VTE risk.

Original languageEnglish (US)
Pages (from-to)305-309
Number of pages5
JournalThrombosis research
Volume134
Issue number2
DOIs
StatePublished - Jan 1 2014

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Keywords

  • neonates
  • risk factor
  • thrombosis
  • venous thromboembolism

ASJC Scopus subject areas

  • Hematology

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