Usefulness of intravenous heparin to prevent thrombosis of central venous catheter in children.

BACKGROUND: central venous catheter (CVC) thrombosis in children is a main issue and its prevention with intravenous heparin is still controversial. The aim of this study was to evaluate efficacy of intravenous heparin in preventing CVC thrombosis both clinically and macroscopically. METHODS: we conducted a randomized clinical trial in a tertiary care children's hospital with patients <18 years of age with CVC. Experimental group included addition of heparin at 2 IU/ml of intravenous fluids (IV), whereas the control group did not include heparin. RESULTS: seventy six lumen of catheters were included, 38 in each group. Both groups were homogeneous in epidemiological variables. Macroscopic thrombus was found in 27 (35.5%) lumen of catheters. The group with heparin showed thrombus in 7.8% and 63% in the control group (p <0.0001 with relative risk (RR) of 20 and confidence interval (CI) at 95% (5.1-77.2). Clinical evaluation showed adequate flow in the IV of the heparin group in 94.7% and 57.8% in the control group (p <0.001). Blood return through the lumen of catheters with heparin was present in 86.8% and 42.1% in the control group (p <0.001). Mean time for catheters was 14.3 days. There were no side effects or prolonged partial thromboplastin time. CONCLUSIONS: heparin infusion at 2 IU/ml is safe and effective in preventing CVC thrombosis in children.

[Predisposing risk factors that participate in neonatal sepsis mortality rate]. / Posibles factores de riesgo que influyen en la mortalidad por sepsis neonatal.

BACKGROUND: Neonatal sepsis is a frequent diagnosis in neonatal intensive care units and has been associated with a high mortality rate. OBJECTIVE: To determine the possible association between various risk factors and neonatal sepsis mortality rate. DESIGN: Cohort case control. MATERIAL AND METHODS: Two hundred medical records of newborns discharged from a neonatology unit, from January 1998 to June 2002, with a neonatal sepsis diagnosis were reviewed. RESULTS: There was significance in birth weight of 1000 g or less, vein dissection for insertion of central venous catheter, gestational age of 30 weeks or less, and presence of mechanical ventilatory assistance (p < 0.01). Total parenteral nutrition also reached significance but as protective factor (OR: 0.15, CI 95% 0.07 - 0.31) (p < 0.001). The multivariate analysis displayed similar results, except birth weight (p < 0.01). CONCLUSIONS: The above mentioned risk factors should be prevented in as much as possible. A factor to prevent mortality is total parenteral nutrition which should be always employed in cases where this is feasible.