Complications of umbilical artery catheterization in a model of extreme prematurity

• Published in: Journal of perinatology Vol. 29; no. 10; pp. 685 - 692
• Main Authors: McAdams, R M, Winter, V T, McCurnin, D C, Coalson, J J
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.10.2009; Nature Publishing Group
• Subjects: Abnormalities; Actin; Animals; Animals, Newborn; Aorta; Aortic Diseases - etiology; Aortic Diseases - pathology; Biomedical research; Blood clot; Blood pressure; Blood vessels; Catheterization; Catheterization - adverse effects; Catheters; Complications; Coronary vessels; Critically ill children; Disease Models, Animal; Drug therapy; Female; Health aspects; Humans; Hyperplasia; Immunocytochemistry; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - etiology; Infant, Premature, Diseases - pathology; Intensive care; Intubation; Laboratories; Male; Medical instruments; Medicine; Medicine & Public Health; Methods; Muscles; Necropsy; Neonates; original-article; Papio; Pediatric Surgery; Pediatrics; Placement; Risk factors; Smooth muscle; Stents; Surfactants; Thrombosis; Thrombosis - etiology; Thrombosis - pathology; Umbilical Arteries; Umbilical venous catheter; Veins & arteries; Ventilation; Ventilators; United States; United States > US; aorta; thrombosis; baboon; infant
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2009.73

Objective: Umbilical artery catheter (UAC) use is common in the management of critically ill neonates; however, little information exists regarding the anatomic and vascular effects of UAC placement in premature newborns. Study Design: Baboons were delivered at 125 days of gestation (term=185 days), treated with surfactant, had UACs placed and were ventilated for either 6 or 14 days. Animals were assigned to short-term (6 days, n =6) and long-term (14 days, n =30) UAC placement. At necropsy, aortas were removed with UACs still in place. Histological examination of upper, middle and lower aorta specimens stained with hematoxylin and eosin and immunolabeled to detect smooth muscle (α-actin) was carried out in a blinded manner. Controls were delivered at 125, 140 and 185 days and the aortas acquired immediately after birth. None of the non-catheterized control animals (125 days, n =4; 140 days, n =5; and 185 days, n =5) had aortic vessel thrombi or vascular wall abnormalities. Result: All 6 animals with short-term (6/6, 100%) and 18 animals with long-term (18/30, 60%) UAC placement displayed aortic thrombi and neointimal proliferation of the vascular wall. The majority (60%) of analyzed animals with UAC placement displaying neointimal hyperplasia were immunopositive for α-actin, indicating the presence of smooth muscle in these lesions. Conclusion: Our findings suggest that both short- and long-term UAC use is associated with aortic wall pathological abnormalities compared with control animals. This study emphasizes the judicious use and early removal of UACs if possible in order to potentially prevent significant hemostatic and aortic wall vascular complications.