163 Central venous catheter associated bloodstream infections and thrombosis in patients treated for gastroschisis and intestinal atresia Chapter 6 and safety of prophylactic low molecular weight heparin should be assessed in a welldesigned trial in this population. In older children, up to 18 years of age, it has been suggested that catheters inserted directly into a central vein decrease the risk of symptomatic thrombosis due to the comparatively larger lumen of the central veins [3]. In our cohort this hypothesis could not be proven. Although the catheter was removed in all patients who experienced thrombosis, some suggest that spontaneous regression of the thrombosis within 28 days can occur in 50% of the children [23]. For this reason, an ongoing multicentre Dutch prospective observational cohort study (Trial registration: Dutch Trial Register . Registered 24 December 2013), which protocol has been published in 2018, aims to evaluate a new treatment strategy. In this protocol non-occlusive thrombosis in neonates admitted to the NICU is treated by “watchful waiting”. In case of non-extension after 5 days, a thrombosis will be followed-up by ultrasound without anticoagulant treatment [23]. This study could not evaluate compliance to preventative measures (such as hand hygiene and skin preparation) which are in place to prevent CLABSI, due to the retrospective design [24]. This is a limitation of our study. Compliance to these measures has shown to able to decrease the incidence of CLABSI in neonates [25, 26]. Secondly, as explained previously, the definitions used for CLABSI might have resulted in different outcomes as would have been the case for catheter related thrombosis if we would have included non-symptomatic thrombosis. In both cases we tried to use a definition which resulted in the clinically most relevant results. If we would have followed the official CDC definition for CLABSI more strictly our results would not have been a true reflection of the number of patients treated due to a presumed CLABSI. Although incidence might have differed, our sensitivity analysis showed that the same risk factors would have been identified if we had chosen to only include CLABSIs that led to catheter removal. The definition for catheter related thrombosis could have been widened by including non-symptomatic thrombosis. This would have increased our incidence, though presumably only slightly due to the rarity of non-symptomatic thrombosis in this cohort. Yet, the clinical relevance of non-symptomatic thrombosis is debatable which is why we chose not to include them. Lastly, some factors, such as catheter size, which specialist inserted the catheter, experience of the specialist, were not clearly described and could thus not be evaluated. Taking these limitations into account when interpreting our results, we still were able to approach the incidence and evaluate risk factors in a specified cohort which increases the interpretability of our results compared to studies including multiple age groups or diseases.
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