IATROGENIC VASCULAR-LESIONS IN EXTREMELY LOW-BIRTH-WEIGHT AND LOW-BIRTH-WEIGHT NEONATES

Purpose: Aggressive treatment has improved the long-term outcome of ex tremely low birth weight (ELBW) and low birth weight (LBW) neonates, b ut it has also increased the risk of iatrogenic lesions. The aim of th is paper is to evaluate the incidence of vascular injuries observed in the neonatal intensive care unit of our hospital. Methods: From 1987 to 1994, 2898 neonates were admitted to the neonatal intensive care un it; 335 of them were either LBW or FLBW (11.5%). A review of the chart s of these neonates disclosed nine neonates (four male, five female) w ith vascular lesions (2.6%); the mean gestational age of these patient s was 28.7 weeks (range, 24 to 33 weeks), the mean weight at birth was 880 g (range, 590 to 1450 g), and the mean weight at diagnosis was 18 25 g (range, 1230 to 2700 g). In the same period, 10 neonates with vas cular injuries were reported in the 2563 neonates who weighed more tha n 1500 g (0.3%). The injuries observed in LBW and ELBW group were arte riovenous fistulas (two bilateral) at the femoral level (six neonates) , carotid lesion (one neonate), and limb ischemia (two neonates). Inju ry was associated with venipuncture in seven neonates, and with umbili cal catheter in one; the case of carotid lesion was related to surgica l error. No general symptoms were observed. Results: The carotid lesio n and five arteriovenous fistulas were repaired by microsurgical techn iques; one case of limb ischemia was resolved with thrombolytic drugs, whereas an amputation at the knee level was required in the other aft er 10 days of medical treatment. One neonate with an arteriovenous fis tula was just observed according to the parents' wishes. At clinical a nd echo-color Doppler follow-up, seven of nine neonates had normal vas cular function without sequelae. Conclusions: In our experience, LBW a nd ELBW neonates are at greater risk than older neonates of the develo pment of iatrogenic vascular lesions. We advocate aggressive microsurg ery, medical treatment, or both to obtain good results and prevent lat e sequelae.