Does Umbilical Vein Catheterization Lead to Portal Venous Thrombosis? Prospective US Evaluation in 100 Neonates

Kim, Ji Hye; Lee, Young Seok; Kim, Sang Hee; Lee, Seon Kyu; Lim, Myung Kwan; Kim, Hyung Sik

doi:10.1148/radiology.219.3.r01jn17645

Cited by 167 publications

(173 citation statements)

References 23 publications

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“…In previous reports, the UVC-associated thrombosis incidence depends on the type of the study and the timing of the study in relation to catheter removal. 4,10,27,32 The incidence of UVC-associated thrombosis in our study was 21.4% and is comparable to previous studies. The majority of clots were in the IVC; all babies were asymptomatic and managed conservatively.…”

Section: Discussionsupporting

confidence: 90%

“…[6][7][8][9] Thrombosis complicating UVC use is also common, with a reported incidence of 4.1 to 44%. 4,10,11 There has been a recent flourish in the identification of genetic abnormalities associated with increased thrombotic risk. Genetic prothrombotic factors are more prevalent in patients with spontaneous and catheter-associated thrombosis compared to the general population.…”

Section: Introductionmentioning

confidence: 99%

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Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

et al. 2007

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Objective: To evaluate the prevalence of hereditary prothrombotic mutations, and their effect on the incidence and severity of umbilical arterial or venous catheter (UAC or UVC)-associated thrombosis.Study Design: All neonates with a UAC or UVC were studied prospectively for the presence, severity and timing of thrombosis with duplex Doppler ultrasound scan. Genetic testing for factor V Leiden (FVL), prothrombin mutation (PTm) and methylene-tetrahydrofolate reductase (MTHFR) mutations was performed using PCR and restriction fragment length polymorphism assays.Result: Umbilical catheter (UC)-associated thrombosis developed in 16/53 (31%) neonates; 23% of UACs and 22% of UVCs were associated with thrombosis. The prevalence of a significant prothrombotic mutation was present in 10/51 (20%) of infants: FVL (8%), MTHFR667 homozygosity (10%), MTHFR1298 homozygosity (2%) and PTm (0%). There was no increase in the risk of UC-associated thrombus in patients carrying these prothrombotic mutations; our study had the power to detect a 2.5-fold increased risk of thrombosis for any of these significant mutations. In addition, MTHFR667 heterozygosity was found in 41% of infants and MTHFR1298 heterozygosity in 52% and also were not associated with increased risk of UC-associated thrombus. The risk of MTHFR double heterozygosity (db het) was 14%, the risk of a significant or db het was 17/51 (33%) and the risk of any mutation was 90%.Conclusion: Prothrombotic genetic mutations are common in our Neonatal Intensive Care Unit population but do not appear to increase the risk of UC-associated thrombosis.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

et al. 2007

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“…For example, prolonged indwelling catheters, respiratory distress, and mechanical ventilation can all increase PLT consumption. [22][23][24][25][26][27] Figure 4 illustrates that thrombocytopenia is more persistent than generally recognized, particularly in the smallest infants. Noninfected, unventilated, AGA infants born at less than 27 weeks gestation exhibited prolonged risk of thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Thrombocytosis and Thrombocytopenia in Hospitalized Neonates

McPherson

Juul

2004

J Perinatol

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We sought to identify changes in platelet (PLT) counts over time, and to evaluate the patterns of thrombocytopenia and thrombocytosis in hospitalized infants 23.8 weeks to term gestation. STUDY DESIGN:Neonates were divided into four gestational age groups and their PLT counts were retrospectively compared for prevalence of thrombocytopenia, thrombocytosis, and associated conditions. RESULTS:Postconceptional age, postnatal age, and sepsis (among other factors) affected PLT counts. When counts from noninfected appropriately grown infants were evaluated, the risk of thrombocytopenia and thrombocytosis were highest in the most preterm infants, and these risks changed with corrected gestational age. PLT counts increased weekly over the first 4 weeks of life for all but the most preterm infants. CONCLUSIONS:These data characterize the incidence of thrombocytopenia and thrombocytosis across a wide range of gestational ages and show that, even in noninfected neonates, these conditions are common, and risk decreases with increasing maturity. The age-related changes in PLT patterns may reflect maturation of platelet regulation.

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“…In addition, UVCs are associated with short and longer term complications including misplacement, extravasation, and thrombosis. 11 The most commonly used alternative mode of venous access is peripherally inserted central catheters (PICCs). [12][13][14][15][16][17][18][19][20] These catheters provide prolonged central venous access, are considered cost effective, 21,22 and have a longer indwelling time before the risk of LOS increases.…”

Section: What This Study Addsmentioning

confidence: 99%

Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates

Shalabi¹,

Adel²,

Yoon³

et al. 2015

Pediatrics

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OBJECTIVE: To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks’ gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. METHODS: This retrospective matched cohort study examined data from infants born at <30 weeks’ gestation and admitted between January 2010 and December 2013 to neonatal units in the Canadian Neonatal Network. Eligible infants who received a PICC on the first day after birth (day 1) were matched with 2 additional groups of infants, those who received a UVC on day 1 and those who received a UVC on day 1 that was then changed for a PICC after 4 days or more. The primary outcome was number of infants with CABSI per 1000 catheter days, which was compared between the 3 groups using multivariable analyses. RESULTS: Data from 540 eligible infants were reviewed (180 per group). There was no significant difference in infants with CABSI/1000 catheter days between the 3 groups (9.3 vs 7.8 vs 8.2/1000 catheter days, respectively; P > .05) despite lower rates of late onset sepsis in the group of infants who received only a UVC. CONCLUSIONS: There was no significant difference in the incidence of CABSI between very preterm neonates who received a PICC, UVC, or UVC followed by PICC as the primary mode of venous access after birth. A prospective randomized controlled trial is justified to further guide practice regarding primary venous access and reduction of infection.

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Does Umbilical Vein Catheterization Lead to Portal Venous Thrombosis? Prospective US Evaluation in 100 Neonates

Abstract: Portal venous thrombosis is frequently associated with the placement of an umbilical venous catheter, and spontaneous resolution is expected in many cases. The duration of catheter placement should be minimized, and US monitoring is recommended as a guide to catheter removal.

Cited by 167 publications

References 23 publications

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis

Patterns of Thrombocytosis and Thrombocytopenia in Hospitalized Neonates

Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates

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