Risk Factors for Neonatal Thrombosis in the Neonatal Intensive Care Unit -a Case Control Study
Notice bibliographique
Résumé
Abstract Background Neonates admitted to the neonatal intensive care unit (NICU) are an age group most susceptible to thrombosis in pediatrics. Besides central access devices (CAD), maternal and neonatal factors are reported to be associated with thrombosis. This has not been well investigated because of the relatively rare incidence of thrombosis and the inherent heterogeneity of thrombotic events. An assessment of the impact of individual risk factors is an essential step, as appropriate risk stratification is fundamental to evidence based thromboprophylaxis policy. Objective To identify risk factors associated with thrombosis in sick neonates admitted to the NICU. Methods A case-control study was conducted using the Children's Hospital Neonatal Database (CHND) dataset with neonates admitted to the NICU at Ann and Robert H. Lurie Children's Hospital and Nationwide Children's hospital between Jan 2010 and June 2013. Cases were neonates diagnosed with either arterial or venous thrombosis during their NICU stay and controls were matched to the cases in the same patient pool in a 1:4 ratio on the basis of gestational age and presence or absence of CAD. Neonates with a less than 72-hour stays in the NICU or complex congenital heart defects needing surgical repair as well as re-admission data were excluded. Chi-square tests were performed to compare characteristics as well as potential risk factors between cases and controls. A conditional multivariate logistic regression analysis included potential risk factors with p-value<0.1 in chi-square tests and with clinical relevance. Local IRB approval was obtained at both sites. Results A total of 47 cases were identified in 4,122 NICU patients (11.4 per 1,000 patients). There were 32 (68%) males and 27 (57.5%) preterm neonates with thrombosis. On univariate analysis blood stream infections (BSI) and prolonged mechanical ventilation were significantly more common in cases than controls Table 1. A conditional multivariate analysis showed that prolonged mechanical ventilation was independently associated with higher risk of thrombosis (OR 3.03 [95% CI: 1.29, 7.09], p value 0.01 Table 2). Conclusions The incidence of thrombosis appears to be 5 fold higher than that previously reported in a Canadian registry. After matching for CAD and GA, prolonged mechanical ventilation represents an independent risk factor of thrombosis in neonates. This is the largest study of systematic assessment of risk factors in neonates with mechanical ventilation being reported as a risk factor independent of CAD. Larger multi-centered data should confirm the study results for developing evidence-based risk stratification protocols and thrombosis prevention strategies. Table 1. Comparison of characteristics and potential risk factors between thrombosis cases and controls Patients with thrombosis Patients without thrombosis Variable n (%) n (%) p value Total 47 188 Gender (Male) 32 (68.1) 102 (54.3) 0.09 Gestational age at birth ≤32 weeks 18 (38.3) 72 (38.3) 1.00 33-36 weeks 9 (19.2) 36 (19.2) ≥37 weeks 20 (42.5) 80 (42.6) Birth Weight (gms) 0.51 <2500 22 (46.8) 97 (52.2) ≥2500 25 (53.2) 89 (47.8) Maternal antenatal conditions Chorioamnionitis 2 (4.6) 7 (4.3) 0.95 Diabetes 6 (13.6) 27 (16.7) 0.63 Hypertension 14 (31.8) 39 (24.1) 0.30 Antenatal steroids use 13 (27.7) 65 (35.5) 0.31 CAD type 0.35 No 14 (29.8) 56 (29.8) UAC/UVC 3 (6.4) 24 (12.8) PICC 11 (23.4) 53 (28.2) CC/cutdown/tunnel catheter 0 (0) 3 (1.6) Multiple types 19 (40.4) 52 (27.7) Mechanical ventilation (MV)˃48 hrs 27 (57.4) 68 (36.2) 0.008 Respiratory distress syndrome (RDS) 27 (57.4) 101 (53.7) 0.65 Necrotizing enterocolitis (NEC) 4 (8.5) 19 (10.1) 0.74 Hypoxic ischemic encephalopathy (HIE) 3 (6.4) 5 (2.7) 0.21 Meconium aspiration syndrome (MAS) 1 (2.1) 8 (4.3) 0.50 Blood stream infections (BSI) 9 (19.2) 17 (9.0) 0.048 Central line associated BSI (CLABSI) 2 (22.2) 1 (5.9) 0.27 Abdominal and GI surgery 16 (38.1) 50 (31.1) 0.39 Table 2. Odds ratio of thrombosis cases from a conditional multivariate logistic regression model Predictor Odds ratio 95% confidence interval p value Male gender 1.74 0.88-3.72 0.11 Prolonged mechanical ventilation 3.03 1.29-7.09 0.01 BSI 2.19 0.80-6.01 0.12 Disclosures Liem: Global Blood Therapeutics: Consultancy; Fresenius Kabi: Other: DSMB; NHLBI: Research Funding.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».