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Epidemiology of thrombosis in Canadian neonatal intensive care units

Journal of Perinatology volume 40, pages 1083–1090 (2020)Cite this article

Subjects

Abstract

Objective

To assess the rate, location, risk factors, management, and outcomes of neonatal thrombosis (NT).

Design

A retrospective study investigating infants admitted to NICUs in Canadian Neonatal Network between January 2014 and December 2016 and diagnosed with NT. Each infant with NT was matched with an infant without NT.

Results

Of 39,971 infants, 587 (1.5%) were diagnosed with NT: 440 (75%) venous, 112 (19%) arterial, 29 (5%) both. NT rate was 1.4% in full-term and 1.7% in preterm infants. Venous thrombi occurred most commonly in the portal vein and arterial thrombi in the cerebral artery. Conservative management and low molecular weight heparin were the most common treatment modalities. Hospital stay was longer (p < 0.001) in the NT patients, but mortality was similar.

Conclusions

NT was diagnosed in ~15/1000 NICU admissions and most commonly in the portal vein and cerebral arteries. Management varied based on the type and location of thrombi. Large multicenter trials are needed to address the best management strategies.

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Fig. 1: Study flow chart.
Fig. 2: Incidence of neonatal thrombosis per 1000 Neonatal Intensive Care Unit admissions.

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Acknowledgements

The authors gratefully acknowledge all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON for organizational support of CNN. In addition, we thank Sarah Hutchinson, PhD, and Heather McDonald Kinkaid, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals.

Funding

Although no specific funding has been received for this study, organizational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health and individual participating centers. PSS holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada

    Walid El-Naggar, Douglas McMillan, Jehier Afifi, Souvik Mitra & Balpreet Singh

  2. Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada

    Eugene W. Yoon, Shoo K. Lee & Prakesh S. Shah

  3. Department of Pediatrics, London Health Sciences Centre, Western University, London, ON, Canada

    Orlando da Silva

  4. Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada

    Shoo K. Lee & Prakesh S. Shah

  5. Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Totonto, ON, Canada

    Shoo K. Lee

Authors
  1. Walid El-Naggar
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on behalf of the Canadian Neonatal Network Investigators

Contributions

WE-N and PSS conceptualized and designed the study, analyzed and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. EWY collected data, carried out the initial analyses, and reviewed and revised the manuscript. DM, JA, SM, BS, OdS, and SKL contributed to the analysis and interpretation of the data and critically reviewed the manuscript for intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Walid El-Naggar.

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El-Naggar, W., Yoon, E.W., McMillan, D. et al. Epidemiology of thrombosis in Canadian neonatal intensive care units. J Perinatol 40, 1083–1090 (2020). https://doi.org/10.1038/s41372-020-0678-1

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