Prematüreleri bekleyen tehlike: Portal ven trombozları

Abstract

Aim: Umbilical venous catheters are frequently used in the neonatal period. The incidence of umbilical venous catheter-related thrombosis is between 1.3% and 43% in ultrasound scans. This study aimed to determine the incidence and risk of portal vein thrombosis in patients who were hospitalized in the neonatal intensive care unit and underwent umbilical venous catheter insertion. Material and Methods: Premature infants (≤32 gestational weeks) who were hospitalized in a Level III neonatal intensive care unit and underwent umbilical vein catheter placement between 2016 and 2018, were included in the study. The demographic data, clinical risk factors for thrombosis, number of catheter days, catheter locations, times of detection of thrombosis using Doppler ultrasonography, treatment methods and durations, thrombosis follow-up and examinations were obtained retrospectively from the electronic patient files. Results: Ninety-six patients whose complete data could be reached were enrolled in the study. The mean gestational age of the patients was found as 29±2 weeks and the mean birth weight was 1353±369 g. Portal vein thrombosis was detected in 13.5% (n=13) of the patients. Five of the cases of portal vein thrombose were complete occlusion and eight were partial occlusion. All patients with complete occlusion and six patients with partial occlusion were treated with low-molecular-weight heparin for a mean duration of 31±13.8 days. Thrombosis disappeared in 7–120 days in all patients. A thrombophilia mutation was detected in six patients with thrombosis, four of whom had the PAI-1 4G / 5G mutation. Conclusion: Portal vein thrombosis which has a significant place among the causes of portal hypertension in childhood, is mostly asymptomatic in the neonatal period and cannot be recognized clinically. It is important to screen and follow up patients with umbilical vein catheters using Doppler ultrasonography in terms of PVT after catheter removal to prevent long-term complications.

What is the prevalence of portal vein thrombosis following umbilical venous catheter insertion in very preterm neonates?

“…Following screening of a total of 228 titles and abstracts, 42 studies were reviewed in full, and 5 studies were included in this evidence review (online supplemental table). 1–5 Two studies described the same population from a randomised controlled trial1 2; therefore, we will describe only the paper which included secondary outcomes (table 1). 1…”

“…Of the four studies reporting thrombosis in the preterm population included in this review, all used either serial ultrasound or echocardiography to detect clinically asymptomatic thrombi. Portal vein thrombosis is mostly asymptomatic in the neonatal period and cannot be recognised clinically 4. Preventing catheter malposition in the left portal vein reduces the occurrence of portal venous thrombosis,3 and ultrasonography can assist with achieving correct positioning during insertion 6.…”

“…To date, there are no evidence-based guidelines on the management of UVC-associated neonatal portal vein thrombosis, and there is sparse evidence regarding treatments such as thrombolysis, surgical thrombectomy or anticoagulation either for treatment or prophylaxis 14. Çakır et al found that all cases of portal vein thrombosis resolved, with low molecular weight heparin administered to infants with complete obstruction and no treatment for those with partial obstruction 4. However, infants in the other three studies did not undergo treatment, and resolution of thrombus was observed regardless 1 3 5…”

“…The prevention of UVC-related thrombosis and occlusion with use of anticoagulants remains debatable. Two of the studies used continuous heparin infusion (0.5–1.0 IU.mL) during the period of the study 1 4. A randomised control study demonstrated that heparin infusion of 0.5 IU/mL through the UVC has no effect on catheter-related thrombosis in term and near-term neonates 15.…”