Indira Chandrasekar

This 5-year retro-study determines the prevalence of thrombosis associated with PICC line insertion in infants hospitalized in NICU. Background: Commonly placed central lines in neonatal intensive care units (NICU) include peripherally inserted central catheter (PICC), Umbilical venous lines (UVC) and Umbilical arterial lines (UAC). These central lines are accepted as the standard of care for nutrition and hemodynamic status monitoring. Neonates are known to be at risk for thromboembolism, particularly venous thromboembolism (VTE) related to central catheters. However, little is known about the true incidence of thrombosis and the requirement for therapy in this population Methods: With Institutional Review Board (IRB) approval, a retrospective review of PICC insertions performed at a Level IV Children's Hospital was conducted. The study period was from January 2016 to June 2020, during which, the patients who received lines were further investigated for thrombosis and phlebitis associated with PICC lines. Results: 2645 PICCs were placed on 2337 neonates over 5 year period. There were 194 documented thrombosis (7.3%). 75 PICCs were removed due to a diagnosis of phlebitis without using an ultrasound (2.8%). Lower limb PICCs were associated with a higher incidence of thrombosis (5.7%) compared to upper extremity PICCs (1.7%). 26% of Upper Extremity Thrombosis (UET) required low molecular weight heparin (LMWH) treatment vs 55% of Lower Extremity Thrombosis (LET). During the same period that 75 neonates (2.8%) had PICC lines removed due to phlebitis in the pre-ultrasound period. Conclusion: In the current study, neonates with a lower extremity PICC was associated with higher rate of PICC line thrombosis compared to UE PICC and required anticoagulation therapy more often.

Neonates have distinctive anatomic and physiologic features that predispose them to obstructive sleep apnea (OSA). The overall prevalence of neonatal OSA is unknown, although an increase in prevalence has been reported in neonates with craniofacial malformations, neurological disorders, and airway malformations. If remained unrecognized and untreated, neonatal OSA can lead to impaired growth and development, cardiovascular morbidity, and can even be life threatening. Polysomnography and direct visualization of the airway are essential diagnostic modalities in neonatal OSA. Treatment of neonatal OSA is based on the severity of OSA and associated co-morbidities. This may include medical and surgical interventions individualized for the affected neonate. Based on this, it is expected that infants with OSA have more significant healthcare utilization.