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Perme T. Central Lines and Their Complications in Neonates: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 11:26. [PMID: 38255340 PMCID: PMC10814986 DOI: 10.3390/children11010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the risk factors associated with complications has to be an important part of neonatal care quality management. Presented here is a case of a preterm neonate with cardiac tamponade caused by UVC tip migration. Among complications of central lines are CLABSI, with an incidence of 3 to 21 per 1000 catheter days, and portal vein thrombosis, which is common but probably under-recognised, whereas other mechanical complications such as pericardial and pleural effusions are rare, with an incidence of less than 1%. Complications can cause injury to the neonates, as well as increase the costs of health services because of increases in the length of stay in the NICU. It is recommended that the catheter tip location is confirmed either by X-ray or ultrasonography. In order to minimise the risk of CLABSI, the use of bundles is recommended. Certain recommendations need to be followed when using different types of catheters. Future research is aimed at novel ways of central line securement to minimise mechanical complications and the use of antimicrobial catheters to reduce the rate of CLABSI.
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Affiliation(s)
- Tina Perme
- Neonatal Intensive Care Unit, Department for Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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2
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Solgun HA, Uysalol EP, Bayram C, Terzi Ö, Çetinkaya M, Memur Ş, Aycicek A. Neonatal portal vein thrombosis: risk factors, diagnosis, treatment recommendations and review of the literature. Thromb J 2023; 21:62. [PMID: 37271816 DOI: 10.1186/s12959-023-00508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Neonatal portal vein thrombosis (PVT) is currently more commonly encountered as a result of advances in diagnostic tools and increase in invasive interventions. METHODS In this study, 11 premature and 12 term infants diagnosed with PVT were retrospectively evaluated for clinical and laboratory characteristics, umbilical catheterization procedure, PVT location, risk factors, treatments, and long-term outcomes. RESULTS Median age of the patients at diagnosis was 10 days (range 3-90 days), and 69.6% of patients were girls. Of the 23 patients, 87% had left PVT and, 91.3% had at least one thrombosis risk factor, which was sepsis in 73.9% of patients, and presence of umbilical venous catheter in 87%. Totally, 59.1% of PVTs were completely resolved in a median follow-up of 7 months (1 month to 12 months), and 78.3% of these patients had no anticoagulant therapy (ACT). Partial thrombus resolution was achieved in 9 patients (40.9%). Five patients (%21) received ACT. Overall, 34.8% of patients had long-term complications. neonatal PVT is most commonly reported in the left portal vein and there is no evidence for the impact of ACT on reducing the short- or long-term complications. Well designed and larger studies are necessary to clarify this issue, which can facilitate developing appropriate management algorithms. CONCLUSION Neonatal PVT is most commonly reported in the left portal vein and there is no evidence for the impact of ACT on reducing the short- or long-term complications. Well designed and larger studies are necessary to clarify this issue, which can facilitate developing appropriate management algorithms.
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Affiliation(s)
- Huseyin Avni Solgun
- Department of Pediatric Hematology and Oncology, Health Sciences University, Basaksehir Cam and Sakura Training and Research Hospital, Istanbul, Turkey.
| | - Ezgi Paslı Uysalol
- Department of Pediatric Hematology and Oncology, Health Sciences University, Basaksehir Cam and Sakura Training and Research Hospital, Istanbul, Turkey
| | - Cengiz Bayram
- Department of Pediatric Hematology and Oncology, Health Sciences University, Basaksehir Cam and Sakura Training and Research Hospital, Istanbul, Turkey
| | - Özlem Terzi
- Department of Pediatric Hematology and Oncology, Health Sciences University, Basaksehir Cam and Sakura Training and Research Hospital, Istanbul, Turkey
| | - Merih Çetinkaya
- Department of Neonatology, Health Sciences University, Basaksehir Cam and Sakura Training and Research Hospital, Istanbul, Turkey
| | - Şeyma Memur
- Department of Neonatology, Health Sciences University, Basaksehir Cam and Sakura Training and Research Hospital, Istanbul, Turkey
| | - Ali Aycicek
- Department of Pediatric Hematology and Oncology, Health Sciences University, Basaksehir Cam and Sakura Training and Research Hospital, Istanbul, Turkey
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3
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Rajaraman N, van Hasselt TJ. What is the prevalence of portal vein thrombosis following umbilical venous catheter insertion in very preterm neonates? Arch Dis Child 2023; 108:411-413. [PMID: 36914232 DOI: 10.1136/archdischild-2022-325243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Nikitha Rajaraman
- Paediatrics and Neonatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tim J van Hasselt
- Neonatal Intensive Care, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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4
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Adlakha V, Wratney A, Gupta S, Imdad A. A Neonate With Abdominal Distention. Clin Pediatr (Phila) 2023; 62:64-67. [PMID: 35822850 DOI: 10.1177/00099228221110687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vaishali Adlakha
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Angela Wratney
- Division of Pediatric Critical Care, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Saurabh Gupta
- Department of Pediatric Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Aamer Imdad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
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5
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Cherrabi H, Oukhouya M, Smahi F, Melllouki M, Ghazy K, Aznague Y, Boutaleb A, Nassik H, benlenda O, Mekkaoui A, Tiski S, wakrim S. Protein C deficiency in a child with inferior vena cava thrombosis following abdominal trauma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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6
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Fort P, Beg K, Betensky M, Kiskaddon A, Goldenberg NA. Venous Thromboembolism in Premature Neonates. Semin Thromb Hemost 2021; 48:422-433. [PMID: 34942667 DOI: 10.1055/s-0041-1740267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While the incidence of venous thromboembolism (VTE) is lower among children than adults, the newborn period is one of two bimodal peaks (along with adolescence) in VTE incidence in the pediatric population. Most VTE cases in neonates occur among critically ill neonates being managed in the neonatal intensive care unit, and most of these children are born premature. For this reason, the presentation, diagnosis, management, and outcomes of VTE among children born premature deserve special emphasis by pediatric hematologists, neonatologists, pharmacists, and other pediatric health care providers, as well as by the scientific community, and are described in this review.
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Affiliation(s)
- Prem Fort
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins All Children's Maternal Fetal and Neonatal Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Kisha Beg
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Marisol Betensky
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Amy Kiskaddon
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neil A Goldenberg
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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7
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Abstract
The incidence of thrombotic disorders in neonates and children is increasing with advances in diagnostic modalities, supportive care, and management of many health conditions. The developing coagulation system, need for intensive care, including catheterization, and co-morbid conditions are responsible for the relatively high risk of thrombosis in neonates compared to older children. This review addresses the advances over the last 3 years in neonatal thrombosis, with a focus on epidemiology, cerebral sinovenous thrombosis (CSVT), renal vein thrombosis (RVT), and portal vein thrombosis (PVT). The incidence of neonatal thrombosis in the contemporary era is reported to be 6.9-15 per 1,000 neonatal intensive care unit (NICU) admissions, compared to 2.4 per 1,000 NICU admissions reported in older registry data. The majority of recently published studies are small, retrospective, and from single centers, albeit they emphasize the need for definitive data to support the efficacy and safety of anticoagulation therapy (ACT) in the management of CSVT, RVT, and PVT. We highlight two important international initiatives geared towards improving the evidence base for these conditions. The International Pediatric Thrombosis Network (IPTN) is a collaboration of 74 centers across 27 countries (as of January 2021) which has started important projects like the international neonatal RVT registry, while the International Pediatric Stroke Study (IPSS) group is in the planning stages of a randomized controlled trial to evaluate the utility of ACT in the management of neonatal CSVT.
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Affiliation(s)
- Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Anthony KC Chan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
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8
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A Rare Case of Total Thrombosis of Ductus Venosus in a Neonate. Pediatr Neonatol 2020; 61:655-656. [PMID: 32768196 DOI: 10.1016/j.pedneo.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
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9
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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.
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10
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Dubbink-Verheij GH, Visser R, Roest AA, van Ommen CH, Te Pas AB, Lopriore E. Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound. Arch Dis Child Fetal Neonatal Ed 2020; 105:299-303. [PMID: 31391204 DOI: 10.1136/archdischild-2018-316762] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Umbilical venous catheters (UVCs) are associated with thrombus formation. Most studies on thrombosis in infants with UVCs focus on only one part of the route, and none assessed a control group of infants without UVCs. OBJECTIVE To determine the incidence and location of thrombi in infants after umbilical catheterisation and compare this with a control group of infants without umbilical catheters. DESIGN Prospective observational study with serial ultrasonography of the UVC route from the umbilico-portal confluence to the heart. Ultrasonography was performed until day 14 after catheterisation in cases and day 14 after birth in controls. RESULTS Thrombi in the UVC route were detected in 75% (30/40) of infants with UVCs in the study group, whereas no thrombi were detected in the control group of infants without UVCs (0/20) (p<0.001). Six thrombi (20%) were located in the right atrium. Most of these were also partly present in the ductus venosus. Six thrombi (20%) were located in the ductus venosus only, and in 12 infants (40%), the thrombus was at least partly located in the umbilico-portal confluence. Thrombi persisted after UVC removal in 25/30 cases. Two infants with thrombotic events were treated with low-molecular-weight heparin and resolution was found. In the other 23 infants managed expectantly, 2 died due to necrotising enterocolitis, 1 was lost to follow-up and in 20 spontaneous regression was seen. CONCLUSIONS Thrombotic events occur frequently in infants after umbilical catheterisation. Most thrombi were asymptomatic and regressed spontaneously with expectant management. Routine screening for thrombi in UVCs is therefore not advised.
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Affiliation(s)
| | - Remco Visser
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Arjan B Te Pas
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Bhatt MD, Patel V, Butt ML, Chan AKC, Paes B. Outcomes following neonatal portal vein thrombosis: A descriptive, single-center study and review of anticoagulant therapy. Pediatr Blood Cancer 2019; 66:e27572. [PMID: 30520242 DOI: 10.1002/pbc.27572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/25/2022]
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.
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Affiliation(s)
- Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Vishal Patel
- Life Sciences Program, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Michelle L Butt
- School of Nursing, and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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12
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Selvam S, Humphrey T, Woodley H, English S, Kraft JK. Sonographic features of umbilical catheter-related complications. Pediatr Radiol 2018; 48:1964-1970. [PMID: 30078110 DOI: 10.1007/s00247-018-4214-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
Umbilical catheters are commonly used in the neonatal period for blood sampling or for administering medication or parenteral nutrition. The position of the catheter is usually confirmed with radiography. However, many complications associated with the use of umbilical catheters, such as liver collections from extravasation or vascular thrombosis, are not apparent on radiographs but can be easily diagnosed with ultrasound. This pictorial review illustrates the sonographic findings of complications that should be excluded in the sick neonate with an indwelling catheter.
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Affiliation(s)
- Swathi Selvam
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK
| | - Terry Humphrey
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK
| | - Helen Woodley
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK
| | - Sharon English
- Department of Neonatology, Leeds Children's Hospital at Leeds General Infirmary, Leeds, UK
| | - Jeannette K Kraft
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK.
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13
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Cabannes M, Bouissou A, Favrais G, Sembély-Taveau C, Morales L, Favreau A, Bertrand P, Saliba E, Sirinelli D, Morel B. Systematic ultrasound examinations in neonates admitted to NICU: evolution of portal vein thrombosis. J Perinatol 2018; 38:1359-1364. [PMID: 30082773 DOI: 10.1038/s41372-018-0132-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/16/2018] [Accepted: 04/16/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of the study was to better describe incidence, risk factors, and the natural evolution of neonatal portal vein thrombosis (PVT). STUDY DESIGN One hundred and twenty-three premature newborns or with birth weight <1.5 kg were prospectively included in a single center during a one-year period. Three systematic abdominal ultrasound examinations at day 3, day 10, and day 45 (and 1 year in case of persistent PVT) were performed. Clinical and biological data were recorded. RESULTS Seventy neonates (57%) had three normal US examinations. Fifty-three neonates (43%) had a clinical and biological asymptomatic left PVT. No right or extrahepatic portal venous thrombosis was observed. Umbilical vascular catheter (UVC) was removed in case of PVT. No anticoagulation therapy was required. No risk factor was significantly associated with PVT. At 1 year of follow-up, five infants had persistent isolated left PVT (4%). CONCLUSION A spontaneous favorable evolution of left PVT occurred in more than of 95%.
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Affiliation(s)
- Mathieu Cabannes
- Department of Pediatric Radiology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France
| | - Antoine Bouissou
- Department of Neonatology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France
| | - Géraldine Favrais
- Department of Neonatology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France
| | - Catherine Sembély-Taveau
- Department of Pediatric Radiology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France
| | - Luciano Morales
- Department of Pediatric Radiology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France
| | - Amélie Favreau
- Department of Neonatology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France
| | - Philippe Bertrand
- Department of Radiology, Bretonneau Hospital, CHRU, 10 Boulevard Tonnellé, Tours, France.,Francois Rabelais University, Faculty of Medicine, Tours, France
| | - Elie Saliba
- Department of Neonatology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France.,Francois Rabelais University, Faculty of Medicine, Tours, France
| | - Dominique Sirinelli
- Department of Pediatric Radiology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France.,Francois Rabelais University, Faculty of Medicine, Tours, France
| | - Baptiste Morel
- Department of Pediatric Radiology, Clocheville Hospital, CHRU, 49 Boulevard Beranger, Tours, France. .,Francois Rabelais University, Faculty of Medicine, Tours, France.
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14
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Sobczak A, Kruczek P, Homa M, Kwinta P. A new microscopic insight into the thrombogenicity of umbilical catheters. Thromb Res 2018; 168:80-82. [PMID: 29936402 DOI: 10.1016/j.thromres.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Alina Sobczak
- Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland.
| | - Piotr Kruczek
- Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland.
| | - Marta Homa
- Centre for High Temperature Studies, Foundry Research Institute, Kraków, Poland.
| | - Przemko Kwinta
- Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland.
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15
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Cox M, Epelman M, Chandra T, Meyers AB, Johnson CM, Podberesky DJ. Non–Catheter-related Venous Thromboembolism in Children: Imaging Review from Head to Toe. Radiographics 2017; 37:1753-1774. [DOI: 10.1148/rg.2017170036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mougnyan Cox
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Monica Epelman
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Tushar Chandra
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Arthur B. Meyers
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Craig M. Johnson
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Daniel J. Podberesky
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
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16
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Abstract
Abdominal venous thrombosis is a rare form of venous thromboembolic disease in children. While mortality rates are low, a significant proportion of affected children may suffer long-term morbidity. Additionally, given the infrequency of these thrombi, there is lack of stringent research data and evidence-based treatment guidelines. Nonetheless, pediatric hematologists and other subspecialists are likely to encounter these problems in practice. This review is therefore intended to provide a useful guide on the clinical diagnosis and management of children with these rare forms of venous thromboembolic disease. Herein, we will thus appraise the current knowledge regarding major forms of abdominal venous thrombosis in children. The discussion will focus on the epidemiology, presentation, diagnosis, management, and outcomes of (1) inferior vena cava, (2) portal, (3) mesenteric, (4) hepatic, and (5) renal vein thrombosis.
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Affiliation(s)
- Riten Kumar
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.,Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, United States
| | - Bryce A Kerlin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.,Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, United States.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
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Romantsik O, Bruschettini M, Zappettini S, Ramenghi LA, Calevo MG. Heparin for the treatment of thrombosis in neonates. Cochrane Database Syst Rev 2016; 11:CD012185. [PMID: 27820879 PMCID: PMC6464761 DOI: 10.1002/14651858.cd012185.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Among pediatric patients, newborns are at highest risk of developing thromboembolism. Neonatal thromboembolic (TE) events may consist of both venous and arterial thromboses and often iatrogenic complications (eg, central catheterization). Treatment guidelines for pediatric patients with TE events most often are extrapolated from the literature regarding adults. Options for the management of neonatal TE events include expectant management; nitroglycerin ointment; thrombolytic therapy or anticoagulant therapy, or a combination of the two; and surgery. Since the 1990s, low molecular weight heparin (LMWH) has become the neonatal anticoagulant of choice. Reasons for its appeal include predictable dose response, no need for venous access, and limited monitoring requirements. The overall major complication rate is around 5%. Whether preterm infants are at increased risk is unclear. No data are available on the frequency of osteoporosis, heparin-induced thrombocytopenia (HIT), or other hypersensitivity reactions in children and neonates exposed to LMWH. OBJECTIVES To assess whether heparin treatment (both unfractionated heparin [UFH] and LMWH) reduces mortality and morbidity rates in preterm and term newborn infants with diagnosed thrombosis. The intervention is compared with placebo or no treatment. Also, to assess the safety of heparin therapy (both UFH and LMWH) for potential harms.Subgroup analyses were planned to examine gestational age, birth weight, mode of thrombus diagnosis, presence of a central line, positive family history for genetic disorders (thrombophilia, deficiency of protein S and protein C, methylenetetrahydrofolate reductase [MTHFR] mutation), route of heparin administration, type of heparin used, and location of thrombus (see "Subgroup analysis and investigation of heterogeneity"). SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 4), MEDLINE via PubMed (1966 to May 9, 2016), Embase (1980 to May 9, 2016), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to May 9, 2016). We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA Randomized, quasi-randomized, and cluster-randomized controlled trials comparing heparin versus placebo or no treatment in preterm and term neonates with a diagnosis of thrombosis. DATA COLLECTION AND ANALYSIS We used the standard methods of the Cochrane Neonatal Review Group. Two review authors independently assessed studies identified by the search strategy for inclusion. MAIN RESULTS Our search strategy yielded 1160 references. Two review authors independently assessed all references for inclusion. We found no completed studies and no ongoing trials for inclusion. AUTHORS' CONCLUSIONS We found no studies that met our inclusion criteria and no evidence from randomized controlled trials to recommend or refute the use of heparin for treatment of neonates with thrombosis.
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Affiliation(s)
- Olga Romantsik
- Lund University, Skane University HospitalDepartment of PaediatricsLundSweden
| | - Matteo Bruschettini
- Lund University, Skane University HospitalDepartment of PaediatricsLundSweden
| | | | | | - Maria Grazia Calevo
- Istituto Giannina GasliniEpidemiology, Biostatistics and Committees UnitGenoaItaly16147
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Romantsik O, Bruschettini M, Zappettini S, Ramenghi LA, Calevo MG. Heparin for the treatment of thrombosis in preterm and term neonates. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rajagopal R, Cheah FC, Monagle P. Thromboembolism and anticoagulation management in the preterm infant. Semin Fetal Neonatal Med 2016; 21:50-6. [PMID: 26553525 DOI: 10.1016/j.siny.2015.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The incidence of preterm thromboembolism has been increasing due to advances in diagnostic imaging which allow better detection of thrombi in sick preterm infants. At the same time, improvement in neonatal intensive care unit supportive care has increased the number of surviving and living preterm infants with thromboembolic risk factors. Disruption in the fine balance of hemostasis with potential risk factors, specifically septicemia and indwelling catheters, increase the occurrence of thromboembolic events. Treatment strategies in preterm infants are challenging due to limited data.
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Affiliation(s)
- Revathi Rajagopal
- Pediatric Hemato-Oncology, Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Fook-Choe Cheah
- Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Paul Monagle
- Department of Clinical Hematology, Department of Pediatrics, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.
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Abstract
Neonates have the highest risk for pathologic thrombosis among pediatric patients. A combination of genetic and acquired risk factors significantly contributes to this risk, with the most important risk factor being the use of central venous catheters. Proper imaging is critical for confirming the diagnosis. Despite a significant number of these events being life- and limb-threatening, there is limited evidence on what the appropriate management strategy should be. Evaluation and treatment of any neonate with a clinically significant thrombosis should occur at a tertiary referral center that has proper support.
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Affiliation(s)
- Matthew A Saxonhouse
- Division of Neonatology, Levine Children's Hospital at Carolinas Medical Center, 1000 Blythe Boulevard, 7th Floor, Charlotte, NC 28203, USA.
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21
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Guidelines for the diagnosis and treatment of extrahepatic portal vein obstruction (EHPVO) in children. Ann Hepatol 2013; 12 Suppl 1:S3-S24. [PMID: 31207845 DOI: 10.1016/s1665-2681(19)31403-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/15/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Extrahepatic portal vein obstruction is an important cause of portal hypertension among children. The etiology is heterogeneous and there are few evidences related to the optimal treatment. AIM AND METHODS To establish guidelines for the diagnosis and treatment of EHPVO in children, a group of gastroenterologists and pediatric surgery experts reviewed and analyzed data reported in the literature and issued evidence-based recommendations. RESULTS Pediatric EHPVO is idiopathic in most of the cases. Digestive hemorrhage and/or hypersplenism are the main symptoms. Doppler ultrasound is a non-invasive technique with a high degree of accuracy for the diagnosis. Morbidity is related to variceal bleeding, recurrent thrombosis, portal biliopathy and hypersplenism. Endoscopic therapy is effective in controlling acute variceal hemorrhage and it seems that vasoactive drug therapy can be helpful. For primary prophylaxis of variceal bleeding, there are insufficient data for the use of beta blockers or endoscopic therapy. For secondary prophylaxis, sclerotherapy or variceal band ligation is effective; there is scare evidence to recommend beta-blockers. Surgery shunt is indicated in children with variceal bleeding who fail endoscopic therapy and for symptomatic hypersplenism; spleno-renal or meso-ilio-cava shunting is the alternative when Mesorex bypass is not feasible due to anatomic problems or in centers with no experience. CONCLUSIONS Prospective control studies are required for a better knowledge of the natural history of EHPVO, etiology identification including prothrombotic states, efficacy of beta-blockers and comparison with endoscopic therapy on primary and secondary prophylaxis.
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Abstract
Neonates have one of the highest risks for thromboembolism among pediatric patients. This risk is attributable to a combination of multiple genetic and acquired risk factors. Despite a significant number of these events being either life threatening or limb threatening, there is limited evidence on appropriate management strategy. Most of what is recommended is based on uncontrolled studies, case series, or expert opinion. This review begins with a discussion of the neonatal hemostatic system, focusing on the common sites and imaging modalities for the detection of neonatal thrombosis. Perinatal and postnatal risk factors are presented and management options discussed.
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Affiliation(s)
- Matthew A Saxonhouse
- Pediatrix Medical Group, Jeff Gordon Children's Hospital, 920 Church Street North, CMC-NE, Concord, NC 28025, USA.
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Abstract
Neonatal portal vein thrombosis (PVT) is an increasingly recognized event. Patients are generally asymptomatic in the neonatal period. The diagnosis is made with Doppler ultrasound. Umbilical catheterization, exchange transfusion and sepsis are risk factors for neonatal PVT. Thrombophilia is possibly a contributing risk factor. Although there are potential serious acute complications such as hepatic necrosis, the outcome is good in the majority of cases, followed up to 8 years of age. Thrombus resolution occurs in 30-70% in days to months. Liver lobe atrophy may occur following PVT, and does not appear to be associated with any impairment of liver function. Non-occlusive thrombosis is more likely to resolve than non-occlusive thrombosis. A subset of patients without resolution is at risk for developing portal hypertension over the next decade of life. There are no current defining features present during the neonatal period to enable identification of neonates at risk for portal hypertension. There is no evidence that anticoagulation therapy improves time to resolution or decreases the likelihood of portal hypertension. Anticoagulation therapy may be considered. A management algorithm is proposed.
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