Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Abstract

Background Neonatal portal vein thrombosis (PVT) is uncommon with potentially serious complications that may manifest in infancy and childhood. Objective The primary aim of our study was to describe the short‐term and long‐term outcomes of neonatal PVT. Methods A retrospective chart review was conducted from 2008 to 2016 of neonates diagnosed with PVT. A systematic review was also performed from 2000 to 2018 to evaluate anticoagulant therapy (ACT) in neonatal PVT. Results Forty‐four premature and 30 term infants (mean gestational age 30.7 vs 39.1 weeks, respectively) had PVT. Sixty‐eight involved the left portal vein, one involved only the main portal vein, and 5 involved ≥1 vein. PVT was catheter associated in 46 (62%); none of the 7 neonates tested had thrombophilia. Of 74 neonates, 19 (26%) received ACT and 55 (74%) were untreated. The mean follow‐up duration was 16.6 months (SD = 17.62; range, 0–89.6); 59.5% were followed for ≥6 months. On last ultrasound examination, thrombus resolution was documented in treated (ACT; n = 19) and nontreated (n = 55) neonates: 12 (63%) versus 32 (58%) with complete resolution, 1 (5%) versus 6 (11%) partial, 0 versus 1 (2%) extension, and 6 (32%) versus 16 (29%) had nonprogressive lesions, respectively. Seventy‐one (96%) had no complications. Seventy‐one articles met inclusion criteria for the systematic review and 19 were retained for analysis after assessment. Conclusions PVT resolution rate was similar to previous reports. Although a low complication rate was detected, longer follow‐up is necessary to determine the need for early treatment and the precise incidence of outcomes such as portal hypertension.

Portal vein thrombosis and food protein-induced allergic proctocolitis in a premature newborn with hypereosinophilia: a case report

“…In the majority of cases, neonatal PVT affects the left portal vein encompassing umbilico-portal confluence, is clinically silent, is associated with UVC, particularly inadequate peripheral placement of catheter tips under the diaphragm, and shows favorable shortterm outcomes with spontaneous resolution of the most thrombi without anticoagulant or fibrinolytic therapy [16,20,21]. However, serious complications including liver lobe atrophy, portal hypertension and gastrointestinal hemorrhage can develop later in childhood largely in persistent, extensive and occlusive PVT [20,22]. A recent prospective case-control study on thrombosis in the UVC route with serial ultrasound screening did not demonstrate any thrombus forming process in 20 matched control neonates at 27-41 weeks' gestation without UVC until median day 13 (1-17) after birth [16].…”

Prematüreleri bekleyen tehlike: Portal ven trombozları

“…It is thought that most catheter-related neonatal cases of thrombosis are associated with acquired causes and routine thrombophilia mutation study is not recommended ( 12 ). In a small number of studies that examined the genetic factors causing a predisposition to thrombophilia in patients with portal vein thrombosis, different results were reported ( 5 ). Although a significant correlation was not found between Factor V Leiden and MTHFR mutation and the risk of UVC-related thrombosis in one study, significantly higher rates of Factor V 1691 GA, MTHFR mutations, and increased homocysteine levels were found in subjects who developed PVT in another study ( 5 ).…”

“…In a small number of studies that examined the genetic factors causing a predisposition to thrombophilia in patients with portal vein thrombosis, different results were reported ( 5 ). Although a significant correlation was not found between Factor V Leiden and MTHFR mutation and the risk of UVC-related thrombosis in one study, significantly higher rates of Factor V 1691 GA, MTHFR mutations, and increased homocysteine levels were found in subjects who developed PVT in another study ( 5 ). In our study, a mutation was found in a total of six patients, including three patients with partial obstruction and three patients with complete obstruction.…”

“…Portal vein thrombosis leads to serious complications such as hepatic atrophy and portal hypertension in the long term and can be recognized only by ultrasonographic screening because it is asymptomatic in the neonatal period ( 5 ). In the screening of PVT, ultrasonography can be frequently used as a reliable method ( 6 ).…”

Clinical rationale for the treatment tactics of term patients diagnosed with transient neonatal tachypnoea without parenteral nutrition

“…Кроме того, установка любого венозного доступа помимо лечебной цели несет в себе риски инфекционных (флебит, катетер-ассоциированный сепсис) [16,17] и тромботических осложнений [18,19], неадекватного подбора дозы жидкости и электролитов, возможности экстравазации катетера [20][21][22][23]; является фактором риска ятрогенной травмы, связанным с уровнем клинического опыта медицинских сестер [24], сопровождается болевым синдромом [25,26] для новорожденного и требует адекватной анальгезии [27,28].…”