160 Chapter 6 Total number of patients included (N= 238) Intestinal atresia (N = 175) Gastroschisis (N = 63) Central venous catheter dwell time (IQR) 20 days (13 – 30) 25 days (14 – 38) CLABSI 53 (30%) 29 (46%) Median time until CLABSI (IQR) 16 days (8 – 28) 19 days (12 – 41) Thrombosis 12 (7%) 4 (6%) Median time until thrombosis (IQR) 11 days (6 – 17) 17 days (14 – 35) CLABSI and thrombosis at the same time 8 (5%) 4 (6%) Removal due to other complications Occlusion 2 (1%) 2 (3%) Dislocation 7 (4%) 8 (13%) Leakage 2 (1%) 0 Death due to central venous catheter complication 1 (1%) 0 No central venous catheter complications 108 (62%) 25 (40%) Received a new central venous catheter 33 (19%) 26 (41%) Discussion In our cohort of 238 patients with intestinal atresia or gastroschisis receiving a central venous catheter, the overall incidence of CLABSI was 35%. Out of the patients treated for intestinal atresia, 30% developed a CLABSI and 46% of the gastroschisis patients developed CLABSI. A catheter related thrombosis developed in 7% of all patients. In those treated for intestinal atresia 7% developed thrombosis whilst the same occurred in 6% of the patients treated for gastroschisis. Patients experiencing CLABSI stayed in the hospital significantly longer than those that did not. Moreover, children treated with an enterostomy and non-tunnelled catheters were significantly more at risk of CLABSI development Also, catheter dwell time was shorter and CLABSIs developed faster in non-tunnelled compared to tunnelled catheters. A catheter related thrombosis occurred significantly more often in non-tunnelled catheters, whilst there was no correlation with direct insertion into a central vein or peripheral insertion. Previous studies in a general neonatal population showed that CLABSIs lengthen duration of hospital stay, increase costs and lead to severe complications including mortality [12]. Yet, there are just two studies that evaluated CLABSI and catheter related thrombosis as a primary outcome in neonates treated for intestinal atresia and gastroschisis. These studies retrieved their data from national databases using coding systems such as ICD-10. These studies report a CLABSI occurrence between 2-4% for those treated for gastroschisis, which is much lower than our cohort [6, 7]. Other studies report a higher occurrence, namely 18% in patients treated for intestinal atresia and 13% in children treated for gastroschisis [13, 14]. These studies were single centre retrospective cohort studies that reported on CLABSI as secondary outcome and which collected the data manually. National databases
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