1291 LIMB BLOOD FLOW FOLLOWING UMBILICAL ARTERY CATHETERIZATION (UAC)

Thrombosis of major blood vessels following UAC is a known complication, sometimes resulting in fatal outcome. We used Doppler ultrasound technique to detect blood flow & to measure blood pressure (BP) in limbs. Pressure index (PI); the ratio of ankle BP to brachial BP was calculated. A value of >1.0 was considered normal. We studied 10 normal s UAC and 20 sick newborns c UAC. In normal newborns, x B.Wt. was 2.8±0.15 kg & x GA was 37±0.9 wks. PI in Rt leg was 1.06±0.006 and Lt leg was 1.05±0.006. In newborns c UAC, x B.Wt. was 2.6±0.19 kg & x GA was 36.8±0.9 wks. In 15/20 newborns s thrombosis PI was 0.88±0.04 in Rt leg, 0.92±0.06 in Lt leg. In 5/20 sick newborns were detected to have art. thrombosis and were serially followed. PI in these was 0.094±0.08 in Rt leg and 0.56±0.2 in Lt leg. This was significantly (p<0.001) lower than both normal newborns s UAC and in newborns c UAC but no thrombosis. These data show that PI c and s UAC is not different. However once thrombosis sets in, PI drops significantly. 2/5 newborns c thrombosis were surgically treated, 1 was treated c urokinase followed by heparin, l c only heparin and l recovered spontaneously. All survived. Followup studies showed return of blood flow and PI to normal in 4/5 newborns by 10-28 days. In l that did not have thrombectomy or thrombolytic therapy, PI returned to normal after 8 wks. This study indicates that serial followup by Doppler ultrasound provides a noninvasive method of dection of thrombosis of major arteries following UAC. Early intervention by medical or surgical therapy leads to better prognosis.