162 Chapter 6 The increased risk of CLABSI in patients who are treated by enterostomy formation, which in this cohort mostly consisted of patients with an intestinal atresia receiving an ileo- or jejunostomy, might be partly related to the risk of high-output enterostomies which occurs in 50-60% of these patients [17, 18]. This in turn could lead to malnutrition which will make these patients more susceptible for systemic infections originating from bacteria which, particularly in neonatal ill patients with intestinal obstructions, seem to translocate from the gut [19, 20] Since the amount of stoma output was not well described in our cohort, we could not evaluate the influence of high-output enterostomies on CLABSI. When it comes to CLABSI prevention in our cohort, we show that tunnelled central venous catheters seem to be preferred over non-tunnelled central venous catheters most specifically when a long duration of parenteral nutrition is expected. However, previous studies show conflicting results. Some show that dwell time does not affect CLABSI-risk and that it occurs less often in non-tunnelled central venous catheters in NICU patients in general [21]. We focussed specifically on a cohort of patients with congenital gastrointestinal diseases, which necessitates long-term parenteral nutrition. In the previous study in NICU patients, almost 50% of the non-tunnelled catheters were removed without complications within a week of dwell time, whilst this was the case in nearly 10% of the tunnelled catheters [21]. It thus seems that in this study patients who were less prone to long-term feeding difficulties were more likely to be treated by a non-tunnelled catheter. This could have resulted in selection bias which in turn could explain the difference with our cohort. Although some form of selection bias might have occurred in our cohort based on the patient’s clinical status or the preference of the treating physician, it seems plausible that this bias is more profound in studies including multiple diseases. The central venous catheter related thrombosis incidence in patients treated for intestinal atresia was found to be 8% in a previous study including 47 patients treated for jejunoileal atresia, which is similar to our results [13]. To our knowledge, there is no study describing the incidence of this complication in patients treated for gastroschisis. Our incidences are lower than the 6-30% reported in cohorts of children up to 16-18 years of age. This could be caused by the amount, commonly near 20%, of patients treated for cancer in these cohorts as well as older age. Treatment for cancer is in itself a risk factor for thrombosis [3, 22]. Furthermore, the inclusion of non-symptomatic thrombosis in these studies will have led to an increase in incidence whilst the clinical significance of these thrombosis is debatable. Still, it seems that this complication is not uncommon. It might be that lowering the threshold for giving prophylactic low molecular weight heparin, which at the moment is set at an expected catheter dwell time of six weeks in our clinic, might decrease the occurrence of thrombosis specifically in this cohort. However, the efficacy
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