Clinical Outcomes of Neonatal Central Line-Related Thrombosis: A Multicentric Retrospective Cohort Study
Bibliographic record
Abstract
Introduction: Neonates are particularly at risk of thromboembolism (TE), especially neonates requiring central lines. Management of neonatal TE is particularly complex, as the higher risk of bleeding must be balanced with the thrombotic risks, including organ dysfunction, post-thrombotic syndrome and death. The objectives of this study are to describe the treatment modalities and to compare the effectiveness and safety between antithrombotic treatment modalities among neonates with central line-related TE. Methods: A multicentric retrospective cohort study enrolled neonates ≤28 days of life requiring a central line with a radiologically confirmed TE in the anatomical territory of the central line, admitted in one of eight Canadian NICUs (2013-2018). Data from the Canadian Neonatal Network registry were linked to clinical outcomes of interest in individual medical records, namely TE resolution and TE progression within three months, major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) defined using ISTH criteria. Logistic regression explored predictors of anticoagulation use and whether treatment modality predicted clinical outcomes. Institutional review boards of all sites approved the study. Results: Overall, 417 neonates sustained a TE diagnosed at a median of 12 days (25-75th percentile: 6-27) after birth. Of those, 81% (n=338) had a venous thrombosis and 19% (n=73) had an arterial thrombosis. Neonates had a median gestational age of 33 weeks (range: 27-38) with a median birth weight of 2.2 kg (range 0.9-3.2). Associated medical conditions were common in these children, such as congenital heart defects (51%), respiratory distress syndrome (47%), necrotizing enterocolitis (16%), and sepsis (9%). While umbilical venous catheters (n=72%), picclines (n=52%) and umbilical arterial catheters (n=31%) were the most common types of central line associated with TE, several patients had more than one central line in place during their admission. Expectative management with or without central line removal, anticoagulation and other treatment strategies (thrombolysis or antiplatelets) were used in 59%, 39% and 2% of patients with venous TE, respectively. For arterial TE, anticoagulation was more commonly used (52%) followed by expectative management (38%), antiplatelets therapy (6%) and thrombolysis (4%). In addition, older gestational age (p=0.002), male sex (p=0.04), occlusive TE (p<0.001), and TE location (p<0.001) were independently associated with anticoagulation use for venous TE. However, for arterial TE, only neonates with older gestational age were being treated significantly more often with anticoagulation (p=0.02). Complete TE resolution and progression occurred in 43.5% and 2.3% of patients, while MB and CRNMB happened in 7.4% and 4.3% of neonates. Clinical outcomes for venous TE did not significantly differ based on treatment modality (TE resolution: p = 0.26, TE progression: p = 0.3, MB: p = 1.0, CRNMB: p = 0.051). For arterial TE, there was no difference in the rate of MB (p=0.43) based on the treatment modality. However, there was a significant improvement of the TE resolution in the anticoagulation group (p=0.003). Conclusion: Anticoagulation was often withheld in neonates with perceived lower thrombotic risk or higher bleeding risk, and expectative management was not associated with unfavourable outcomes. Further prospective studies are needed to tailor the treatment of neonatal central line-related TE using a patient-centred approach.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".