SPA Newsletter

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Short term Use of umbilical Artery Catheters may not be Associated with Increased Risk For Thrombosis.

Reviewed by: Thomas J. Mancuso, MD, FAAP

This study was designed to determine prothrombin fragment (F1.2) and thrombin-antithrombin (TAT) levels over time and compare those levels with platelet counts and ultrasound evidence of UAC thrombi during the first week of life of sick newborns with UAC's. Infants who had UAC's placed within the first 24 hours of life were included. The study duration was five days. The investigation was a prospective, non-blinded, observational design that enrolled 33 newborns in a six-month period. In this group, only one ultrasound study was positive for an aortic thrombus, there was no significant change of F1.2 or TAT over time. The authors conclude that UAC' in sick newborns may not carry an increased risk of thrombus formation in the first five days of use.

Commentary

Sick newborns come to the OR with indwelling UAC's and on occasion, placement of such a monitor is planned as part of the anesthetic care. This report is useful simply to alert us the possible, albeit rare complication the use of such a monitor has. This report does not specifically address the topic of location of the tip of the UAC but it is important to be aware of where, in the course of the very short aorta of the newborn the tip of the catheter lies. One dose not want to flush anything directly into the PDA, the renal arteries or mesenteric trunk.

It is known that the use of umbilical artery catheters is associated with the quite serious, but rare complication of thrombus formation. The true incidence is difficult to ascertain owing to two factors; the varied methods used to diagnose the problem and the timing of the search for the thrombus. Doppler sonography, aortography, and autopsy have all been used to investigate the problem of thrombosis. Reported incidence is often in the range of 1% but some investigations have had a much higher incidence. Further complicating interpretation of the data, studies have been prospective, others retrospective. Some investigators have reported that clot formation began only after catheter removal.

Table of Contents

• President's Message
• Editor's Corner
• Bylaws Amended
• Genesis of a CPT Code
• Fellow's Corner
  Choosing a Career in Academic Pediatric Anesthesia


• SPA Elections
• Society for Pediatric Anesthesia Election Procedures
• Nominations


• Pediatric Anesthesiology 2004 Meeting Review
  Point Hilton Squaw Peak Resort - March 4-7, 2004
• Friday, March 5, 2004
• Saturday, March 6, 2004
• Sunday, March 7, 2004


• Reviews & Commentary
  • Perception of Child Vulnerability Among Mothers of Former Premature Infants
    Allen EC, Manuel JC, Legault C et al. Pediatrics 2004;113:267-273
  • Billing Practices, Ofri, D; Uninsured, Unwanted, Unworthy?
    Chesleigh, F. The Hastings Center Report Jan-Feb 2004
  • The Effect of Obesity, Gender and Ethnic Group of Left Ventricular Hypertrophy in Hypertensive Children: A Collaborative Study of the International Pediatric Hypertension Association
    Havevold C, Waller J, Daniels S et al. Pediatrics 2004;113:328-333
  • A Cautionary Tale About Supplemental Oxygen: The Albatross of Neonatal Medicine
    Silverman, WA Pediatrics 2004;113:394-396
  • EMLA Toxicity After Application for Allergy Skin Testing
    Parker JF, Vats A, Bauer G. Pediatrics 2004;113:410-411
  • Overweight, Ethnicity and the Prevalence of Hypertension in School-aged Children.
    Soro f JM, Lai DL, Turner J et al. Pediatrics 2004:113:475-482
  • Short term Use of umbilical Artery Catheters may not be Associated with Increased Risk For Thrombosis.
    Coleman MM, Spear ML, Finkelstein M et al. Pediatrics 2004;113:770-774
  • Recurrent Abdominal Pain, Anxiety and Depression in Primary Care.
    Campo JV, Bridge J, Ehmann m et al. Pediatrics 2004;113;817-824
  • The Ancillary-Care Responsibilities of Medical Researchers: An Ethical Framework for Thinking about the Clinical Care that Researchers owe their Subjects.
    Richardson, HS, Belsky L The Hastings Report Jan-Feb 2004;25-33


• Literature Reviews
  • The Effect of Small Dose Fentanyl on the Emergence Characteristics of Pediatric Patients After Sevoflurane Anesthesia Without Surgery
    Cravero J, Beach M, Thyr B, Whalen K. Anesthesia & Analgesia 2003;97:364-367.
  • Epidural analgesia in children. A Survey of Current Opinions and Practices amongst UK Paediatric Anaesthetists.
    Williams DG and Howard RF. Paediatric Anaesthesia 2003;13:769-776
  • Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol.
    Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. Paediatric Anaesthesia 2003;13:63-67

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