14 Chapter 1 bloodstream infections are a major contributor to morbidity and mortality within neonatal intensive care units.[12] The cause of catheter related thrombosis is diverse. A combination of factors, including the insertion of the catheter, reduction of flow through the central vein caused by the catheter and ongoing micro damage caused by movement of the catheter, will active the coagulation cascade resulting in blood clots. These can in turn cause blockage of flow through the vein leading to thrombosis which might necessitate treatment with anticoagulants. The catheters used to administer total parenteral nutrition differ in the mode of insertion, either tunnelled subcutaneously before the vein is entered or non-tunnelled, and the type of vein used, either a small peripheral or a large central vein. The decision between these options is based on a trade-off between the up- and downsides of both options mostly interchanging the chances of the occurrence of thrombosis or infection. Because of this, there is variation in standard of practice between different centres which demands further research into this topic. 3.2. Fecal Obstructive complications Fecal obstructive complications following abdominal surgery can either occur shortly after surgery or later during follow-up. Shortly after surgery, prolonged intestinal paralysis can lead to ileus; a clinical diagnosis characterized by intolerance to oral feeding, nausea and the lack of stool. This complication, mostly resolving by itself in time, is responsible for one-in-five of the unplanned readmissions in the first month following surgery in children in the United States.[13] Later during follow-up, mechanical obstruction caused by adhesions can necessitate redo-surgery for adhesion removal. These adhesions are, partly, an unavoidable reaction to abdominal surgery occurring as part of the natural healing process of intra-abdominal scarring. However, insights into the pathophysiology of adhesions have shown that certain factors, such as intestinal tissue handling and mediation of inflammation might decrease the amount of adhesion formation. This could be seen as an explanation why fewer adhesive obstructions seem to occur following laparoscopies compared to laparotomies.[14] Still, in both treatment options, adhesive obstructions do occur and can necessitate surgery even years after the primary operation. 3.3. Incisional hernia An incisional hernia is a protrusion of tissue at the sight of a surgical scar. This complication is extensively studied in adults but less so in young children. There are two previous studies focussing on these complications in children which suggested that incisional hernias occur between one and three percent when taking all pediatric patients
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