UMBILICAL ARTERY CATHETERIZATION: DEMONSTRATION OF ARTERIAL THROMBOSIS BY AORTOGRAPHY

One hundred consecutive admissions to a neonatal intensive care unit were included in a prospective study designed to ascertain the frequency of clinically silent thrombosis among infants with umbilical artery catheters. Eighteen of 19 infants (95%) had distinct arterial thrombus formation demonstrated by hand injection of contrast media at the time of catheter removal. In addition, 7 of the 12 patients (58%) who died were found to have clots present by necropsy. Only one patient had clinical evidence of vascular occlusion prior to the pullout aortogram, though a second infant became symptomatic 4 hours after the study and subsequently died. Careful selection of patients in whom umbilical artery catheters are inserted is emphasized because of the unexpectedly high incidence of arterial thrombosis associated with this procedure.