152 Chapter 6 Therefore, this retrospective cohort study aims to identify the incidence of and risk factors for CLABSI and central venous catheter associated thrombosis in patients treated for intestinal atresia and gastroschisis. Methods Patients and management Our institute’s data managers retrieved all children undergoing surgery for gastroschisis, intestinal atresia or a combination of both defined as complex gastroschisis between January 1998 and October 2021 from the Amsterdam university hospital database. The local medical ethical commission evaluated the study, it received the reference number W18_233#18.278. An opt-out letter was sent to patients and parents, which they could return within one month if they did not wish to participate. Following this period, patient records were checked. Eventually, the data of the included patients was stored in Castor EDC [8]. The patient reports were read by a dedicated PhD-candidate (LES), in case of doubt a paediatric surgeon (JD) was consulted. Current protocol Our current protocol advises, in case of an estimated need of a central venous catheter for 30 days or less, the placement of a peripheral central venous catheter. These catheters are in general placed by the neonatologist in patients younger than one month and by the anaesthesiologist or interventional radiologist in patients older than one month. If central venous access is estimated to be needed for a period longer than 30 days a centrally placed, tunnelled catheter (Broviac©) is placed by the pediatric surgeon. No preventative measures other than basic hygiene, for instance antibiotic prophylaxis, are recommended to prevent CLABSIs. When it is expected that the catheter will be in place for longer than six weeks low molecular weight heparin is given to prevent thrombosis. Data extraction Patients were categorized according to a diagnosis of intestinal atresia or gastroschisis. A gastroschisis was deemed to be complex when both a gastroschisis and intestinal atresia were diagnosed. Mode of treatment for gastroschisis (SILO or primary closure) was extracted from surgical reports. Moreover the location of the atresia was noted as well as the type of atresia (using the Martin-Zarella classification) in case of jejunoileal atresias [9]. The following comorbidities were noted if present: duodenal web, annular pancreas, malrotation, midgut volvulus and meconium peritonitis.
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