Jessica Gonzalez-Hernandez1, Yahya Daoud1, Jennifer Styers2, Janna M Journeycake3, Nandini Channabasappa4, Hannah G Piper5. 1. Department of Surgery, Baylor University Medical Center, Dallas, TX, USA. 2. Division of Pediatric Surgery, University of Texas Southwestern/Children's Health, Dallas, TX, USA. 3. Division of Pediatric Gastroenterology, University of Texas Southwestern/Children's Health, Dallas, TX, USA. 4. Division of Pediatric Hematology-Oncology, University of Texas Southwestern/Children's Health, Dallas, TX, USA. 5. Division of Pediatric Surgery, University of Texas Southwestern/Children's Health, Dallas, TX, USA. Electronic address: Hannah.Piper@childrens.com.
Abstract
PURPOSE: Central venous thrombosis (CVT) is a serious complication of long-term central venous access for parenteral nutrition (PN) in children with intestinal failure (IF). We reviewed thse incidence of CVT and possible risk factors. METHODS: Children with IF on home PN (2010-2014) with central venous imaging were reviewed. Patient demographics, catheter characteristics and related complications, and markers of liver function were compared between children with and without CVT. Serum thrombophilia markers were reviewed for patients with CVT. RESULTS: Thirty children with central venous imaging were included. Seventeen patients had thrombosis of ≥1 central vein, and twelve had ≥2 thrombosed central veins. Patients with and without CVT had similar demographics and catheter characteristics. Patients with CVT had a significantly lower albumin level (2.76±0.38g/dL vs. 3.12±0.41g/dL, p=0.0223). The most common markers of thrombophilia in children with CVT were antithrombin, protein C and S deficiencies, and elevated factor VIII. There was a statistically significant correlation between a combined protein C and S deficiency and having >1 CVT. CONCLUSIONS: Children with IF on long-term PN are at high risk for CVT potentially owing to low levels of natural anticoagulant proteins and elevated factor FVIII activity, likely a reflection of liver insufficiency and chronic inflammation.
PURPOSE: Central venous thrombosis (CVT) is a serious complication of long-term central venous access for parenteral nutrition (PN) in children with intestinal failure (IF). We reviewed thse incidence of CVT and possible risk factors. METHODS:Children with IF on home PN (2010-2014) with central venous imaging were reviewed. Patient demographics, catheter characteristics and related complications, and markers of liver function were compared between children with and without CVT. Serum thrombophilia markers were reviewed for patients with CVT. RESULTS: Thirty children with central venous imaging were included. Seventeen patients had thrombosis of ≥1 central vein, and twelve had ≥2 thrombosed central veins. Patients with and without CVT had similar demographics and catheter characteristics. Patients with CVT had a significantly lower albumin level (2.76±0.38g/dL vs. 3.12±0.41g/dL, p=0.0223). The most common markers of thrombophilia in children with CVT were antithrombin, protein C and S deficiencies, and elevated factor VIII. There was a statistically significant correlation between a combined protein C and S deficiency and having >1 CVT. CONCLUSIONS:Children with IF on long-term PN are at high risk for CVT potentially owing to low levels of natural anticoagulant proteins and elevated factor FVIII activity, likely a reflection of liver insufficiency and chronic inflammation.
Authors: Ludger Sieverding; Jörg Michel; Christian Urla; Ekkehard Sturm; Franziska Winkler; Michael Hofbeck; Jörg Fuchs; Johannes Hilberath; Steven Walter Warmann Journal: Front Nutr Date: 2022-03-28
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