155 Central venous catheter associated bloodstream infections and thrombosis in patients treated for gastroschisis and intestinal atresia Chapter 6 was treated by primary closure in 64% (N=40/63) of the patients. An enterostomy was created in 23% (N=55/238) of all patients. Following surgery 22% (N=53/238) of the children developed a Clavien-Dindo grade three or higher. Redo-surgery (due to adhesive obstructions, anastomotic leakage or stoma complications) accounted for 66% (N=35/53) of these complications, whilst ICU admission accounted for 26% (N=14/53) and death within 30 days following surgery for 8% (N=4/53) of these complications. All deaths occurred in patients with associated trisomy 21 who experienced a postoperative infection (one caused by an anastomotic leakage, one CLABSI and two cases of sepsis of unknown origin) leading to multi-organ failure which resulted in their deaths. Complications associated with central venous catheter placement Table 3 provides an overview of the central venous catheter associated complications during and following insertion of the first central venous catheter. Out of all patients, a CLABSI developed in 34% (N=82/238) and a catheter associated thrombosis in 7% (N=16/238). This occurrence of CLABSI did not differ if we split the cohort in patients operated before or after the year 2010 (p=0.98) Following placement of the central venous catheter, postoperative readjustment of the catheter tip was the most common complication directly occurring following placement. It occurred occurring in 10% (N=23/238) of the patients treated for intestinal atresia and in 21% (N=13/63) of those treated for gastroschisis respectively. Of these readjustments, 35% (N=8/23) occurred in tunnelled catheters whilst all other were non-tunnelled. Central venous catheter placement did not cause a pneumothorax in any of the patients. The central venous catheter was peripherally inserted in 28% (N=65/238) of all patients (intestinal atresia, 30%, gastroschisis 19%) and directly into a central vein in 72% (N=173/238) of all patients (intestinal atresia: 70%, gastroschisis: 81%). Furthermore, the central line was tunnelled in 73% (N=173/238) of all patients (intestinal atresia: 76%, gastroschisis: 65%). The median catheter dwell time was 20 days (IQR: 13-30) in those treated for intestinal atresia and 25 (IQR: 14 -18) days in those treated for gastroschisis. A CLABSI developed in 35% (N=82/238) and resulted in removal of the central venous catheter in 68% (N=56/82) of the children. Appendix A provides an overview of the pathogens cultured from the blood showing 62% (N=51/82) of the cultured bacteria were common commensals (CNS, S. Epidermis or S. Hominis). CLABSIs that were caused by common commensals did not lead to a significant higher rate of removal of the central venous catheter than those caused by other pathogens (p=0.14). Of all patients treated for intestinal atresia, 30% (N=53/175) developed a CLABSI which occurred after a median of 16 days (IQR: 8 – 28). CLABSI occurred in 46% (N=29/63) of the gastroschisis patients in a median of 19 days (IQR: 12 – 41). Patients that developed a CLABSI related to their
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