Catheter-related risk factors for neonatal venous thrombo-embolism: A systematic review of the literature
Notice bibliographique
Résumé
Abstract BACKGROUND Neonates are at high-risk of venous thrombo-embolism (VTE); central venous catheter (CVC) are related to 90% of VTE in this population. Understanding how catheter-related risk factors impact the risk of VTE in neonates could help elaborate preventative strategies. AIMS To synthetize data pertaining to CVC-related risk factors for VTE in neonates. METHOD A literature search was performed for peer-reviewed randomized and non-randomized trials, retrospective and prospective cohort studies, case-control studies and case series of ≥ 10 patients (1990-2024). Studies were eligible if ≥ 90% of participants were neonates – defined as infants with corrected gestational age ≤ 44 weeks at time of VTE diagnosis – and if studies reported VTE incidence or risk factors, including symptomatic and clinically unsuspected events. Study screening and data extraction were performed independently by two investigators; risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool. We extracted data related to the association of any catheter-related characteristics and VTE, including but not limited to: type of CVC, size, number of lumens, insertion technique, location, and tip position. The review was registered on PROSPERO (CRD42024518801). RESULTS The search yielded 10,579 references, with 283 full-text articles retrieved. Of these, 12 studies (3,352,908 neonates) reported on the predictive impact of catheter-related risk factors for neonatal VTE. Among them, five (42%) were retrospective cohort studies, four (33%) prospective cohort studies, and three (25%) were case-control studies. Most studies focused on neonates admitted to general neonatal intensive care units (NICU) (67%), followed by those focusing on low-birth-weight infants (8%), or neonates with congenital anomaly (8%). VTE screening was performed at least once in 42% of studies. The presence of a CVC was evaluated in four studies, all of which demonstrated a significant association with VTE (ORs: 3.32 to 18.97). The impact of CVC type was not formally compared, but one study (Easterlin et al, 2022) found differing risk based on CVC type (Umbilical vein catheters: OR=2.32; peripherally-inserted central catheters: OR=6.93; tunnelled and untunnelled CVCs: OR=8.50). CVC insertion site was assessed in five studies; three found a significantly increased risk associated with femoral access compared to subclavian access or other sites (ORs: 1.08 to 8.1). CVC duration was investigated in three studies, two of which presented a statistically significant association between prolonged catheter use and increased VTE incidence (ORs: 1.54 and 11.1). Two studies evaluated the use of heparin to prevent catheter-related thrombosis in neonates: one showed a reduction in thrombosis, while the other was inconclusive. Despite the limited and conflicted evidence, heparin remains commonly used in clinical practice, supporting the need for stronger data to support its routine use. No study assessing the impact of insertion technique, inserting clinicians, and CVC size and number of lumens on neonatal VTE was retrieved. CONCLUSIONS CVC are a major risk factor for neonatal VTE. Given the high burden and important morbidity associated with neonatal VTE and the lack of clear, consistent conclusions across existing studies, this review highlights the need for high-quality prospective research to guide safer CVC use in this vulnerable population.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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 | 0,007 | 0,030 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,007 | 0,006 |
| Bibliométrie | 0,014 | 0,014 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 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 ».