Interventional Radiology in the Neonate and Young Infant

Pediatric Biliary Interventions in the Native Liver

“…However, IRs should be mindful that keeping the patient dry is a significant factor in preventing heat loss, particularly in neonates who are less able to regulate their body temperature. 73 Tracking the patient's fluid balance during interventional procedures is especially important in neonates and small infants. Intravascular volume in neonates is approximately 85 to 96 mL/kg; shifts of 10% can cause fluid overload or hypovolemia.…”

“…In neonates and small children, an attempt to limit intravascular contrast dose to less than 3 mL/kg should be made, with a maximum of 10 mL/kg. 73 Although contrast administered for biliary procedures ideally remains within the biliary system, some contrast may be intravascularly injected or absorbed. Therefore, adhering to volume limits for intravascular injection is prudent.…”

“…Chlorhexidine gluconate/isopropyl alcohol is the preferred skin antiseptic for neonates, as iodine from povidone iodine preparations can be absorbed through the skin, affecting thyroid function. 73…”

“…To facilitate contrast filling of intrahepatic bile ducts, the patient can be placed in Trendelenburg position or intravenous morphine can be given to cause sphincter of Oddi spasm. 24,73 Once diagnostic images are obtained, residual contrast material is aspirated through the needle prior to needle removal. To aid hemostasis, 5 to 10 minutes of manual pressure is applied to the puncture site.…”

“…If indicated, ultrasound-guided percutaneous liver biopsy can be performed during the same session. 24,73 Percutaneous Transhepatic Cholangiography and Drain Placement…”