PRELIMINARY RESULTS OF THE ADVENTH-PEDIATRIC REGISTRY IN A SOUTHEASTERN BRAZILIAN CITY

Abstract

Introduction: There is a lack of epidemiological data regarding pediatric venous thromboembolism (VTE) in Brazil. Aims: A registry to evaluate the incidence of VTE in hospitalized children (0 to 16 years) in a southeastern Brazilian city. Methods: A prospective multicenter study initially involving two tertiary hospitals, a pediatric cancer (Boldrini) and a nursery with ICU (Clinical Hospital, UNICAMP), in Campinas, SP-Brazil. All hospitalized patients were evaluated daily, through access to each patient's electronic medical record and those with a diagnosis of VTE by an objective method were included. All patients with a central venous catheter (CVC) were carefully observed and should undergo doppler ultrasound (US) with any sign of VTE. There was no search for asymptomatic VTE. Results and discussion: During Sept2018 to Feb2021, 971 children were hospitalized and 21 cases of VTE were diagnosed, an incidence of 2.1/100 hospital admissions. Demographic and risk factors associated with VTE in children with and without VTE were: bed immobilization 64.4% in non VTE versus 57.1% in VTE patients; The majority of patients with VTE did not make surgery during hospitalization (19% vs. 36.9% in no VTE patients). The VTE patients did not suffer trauma. In relation to CVC 38.1% of patients with VTE presents CVC vs. 27.6% of non VTE patients. The hospitalization time was higher in the group of non VTE mean of 33 days in comparison to 12 days for VTE group. The VTE group presented a higher the necessity of intensive care unit (ICU) 66.7% vs. 32.3% for non VTE group. VTE was located in the upper (n = 8/38.1%) or lower limbs (n = 10/47.6%), portal vein (n = 1/4.8%), and pulmonary embolism (n = 1/4.8%). Regarding presentation, 6 (28.6%) were incidental, 2 (9.5%) malfunctioning CVC and 13 (61.9%) with common signs of VTE. VTE was associated with CVC in 10 (47.6%) cases. The time between CVC insertion and VTE diagnosis was 22.1 days (±43.2). The time between symptoms/diagnosis was 2.5 (±2.5) days. Risk factors for VTE were found in 95% of the children, represented by immobilization (42.8%), infection (66.7%), surgery or intravascular procedure (38.1%), ICU (61.9%) and CVC (47.6%). Corticosteroids and asparaginase were more commonly used in VTE patients (33.3% and 4.8% vs. 22.1% and 0.1%, respectively). Therapeutic anticoagulation was used only in 13 (61.9%) patients, because of thrombocytopenia in those with cancer. Conclusion: Preliminary data from the first Brazilian VTE pediatric registry indicate it is prevalent among hospitalized children, and largely associated to CVC. Approved by Ethics Research Committee of Unicamp.