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    Oral Communication

    Pediatrics

    Clinical and Basic Science Insights Related to Neonatal Hemostasis and Neonatal Thrombosis

    OC 67.5 - Clinical outcomes of neonatal catheter-related thrombosis: a multicenter retrospective cohort study

    Tuesday, June 27, 2023
    15:45 – 16:00 ET
    Room: 518
    Session Available As: On-Demand

      Presenting Author(s)

    • Marie-Claude Pelland-Marcotte, MD PhD (she/her/hers)

      Adjunct Professor
      Centre Hospitalier Universitaire de Quebec, Universite Laval
      Quebec City, Quebec, Canada

      • Co-Author(s)

    • MD

      Marie-Pier Desjardins

      Subspecialty resident, Pediatric Hematology & Oncology
      Children's Hospital of Eastern Ontario
      Ottawa, Ontario, Canada

    • NS

      Narcisse Singbo

      Biostatistician
      Recherche Clinique et Évaluative - Centre de recherche du CHU de Québec
      Quebec City, Quebec, Canada

    • AH

      Audrey Hébert

      Neonatologist
      Centre Hospitalier Universitaire de Québec
      Quebec City, Quebec, Canada

    • AL

      Anie Lapointe

      Neonatologist
      Centre Hospitalier Universitaire Sainte-Justine
      Montreal, Quebec, Canada

    • Christine Sabapathy, MD MSc

      Pediatric Hematologist & Oncologist
      Montreal University Health Center
      Montreal, Quebec, Canada

    • AZ

      Alexandra Zabeida

      Clinical fellow, Pediatric Hematology & Oncology
      The Hospital for Sick Children
      Toronto, Ontario, Canada

    • KK

      Kriti Kumar

      Subspecialty resident, Pediatric Hematology & Oncology
      The Hospital for Sick Children
      Toronto, Ontario, Canada

    • ST

      Soumitra Tole

      Pediatric Hematologist
      Children's Hospital - London Sciences Health Center
      London, Ontario, Canada

    • Mihir D. Bhatt, MD, MSc (he/him/his)

      Pediatric Hematologist
      McMaster Children’s Hospital, McMaster University
      Hamilton, Ontario, Canada

    • ML

      Mira Liebman

      Pediatric Hematologist & Oncologist
      Children's Hospital of Eastern Ontario
      Ottawa, Ontario, Canada

    • JD

      Juliette Déry

      Undergraduate
      Faculté de Médecine, Université Laval
      Quebec City, Quebec, Canada

    • JW

      Jonathan Wong

      Neonatologist
      British Columbia Children's Hospital
      Vancouver, British Columbia, Canada

    • AA

      Ali Amid

      Pediatric Hematologist
      British Columbia Children's Hospital
      Vancouver, British Columbia, Canada

    • MB

      Marc Beltempo

      Neonatologist
      Montreal University Health Center
      Montreal, Quebec, Canada

    Background: Neonates are at high risk of thromboembolism (TE), especially neonates requiring central venous catheters (CVC). Management of neonatal TE is particularly complex, as the higher risk of bleeding must be balanced with thrombotic risks.

    Aims: Describe treatment modalities and clinical outcomes among neonates with CVC-related TE.

    Methods: A retrospective cohort study enrolled neonates ≤28 days of life requiring a CVC for ≥24 hours with a radiologically confirmed TE in the anatomical territory of the CVC, admitted in one of seven 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, 377 neonates (median gestational age: 34.3 weeks, range: 22-41) sustained a TE, diagnosed at a median of 12 days (25-75th percentile: 5-26) after birth (Table 1). Expectative management with or without CVC removal, anticoagulation and other treatment strategies (thrombolysis or antiplatelets) were used in 218 (58%), 149 (40%) and 10 (3%) patients, respectively. Older gestational age, male sex, occlusive TE, and TE location were independently associated with anticoagulation use (Table 2).

    Complete TE resolution and progression occurred in 42.9% and 2.5% of patients, while MB and CRNMB happened in 7.7% and 4.1% of neonates. Clinical outcomes did not significantly differ based on treatment modality (TE resolution: p=0.941, TE progression: p=0.202, MB: p=0.531, CRNMB: p=0.052).

    Conclusion(s): Anticoagulation was often withheld in neonates with perceived lower thrombotic risk or higher bleeding risk, and expectative management was not associated with unfavorable outcomes. Further prospective studies are needed to tailor the treatment of neonatal VTE using a patient-centred approach.

    Learning Objectives:

    • Describe the demographic and clinical characteristics of neonates who experienced a catheter-related thrombosis
    • Describe the use of anticoagulation in neonates with catheter-related thrombosis
    • Estimate the rate of recurrence and the rate of major bleeding of neonates following a catheter-related thrombosis