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Farag MM, Ghazal HAER, Radwan MM, El-Sayed NS. Catheters linked thrombosis in neonates: a single center observational study. Ital J Pediatr 2024; 50:147. [PMID: 39135120 PMCID: PMC11320773 DOI: 10.1186/s13052-024-01708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Central venous catheters (CVCs) are the major risk factors for neonatal thrombosis that might negatively affect morbidity and mortality in neonates. The aim of the present work was to estimate the incidence of CVC-linked thrombosis, among neonates in the NICU of Alexandria University Maternity Hospital, Egypt, over 1year, and to determine its possible risk factors. METHODS This observational cohort study involved 134 newborn infants born from July 2020 to July 2021with CVCs insertion during their hospital stay. Patients who had congenital anomalies, had thrombosis unrelated to the implantation of CVCs or died before 7 days of catheter placement were excluded from the analysis. The 134 neonates who met the study's eligibility requirements had 142 CVCs inserted. Serial ultrasound and Doppler scans on site of venous insertion of catheters were performed. RESULTS Seventeen patients with catheter's thrombosis (12%) were found during the placement of 142 catheters or 1615 CVCs' days, resulting in an overall rate of 10.5 thrombotic events per 1000 catheters' days. We constructed a logistic regression model to identify risk factors behind CVC-linked thrombosis. In univariate analysis, femoral central venous lines (CVLs), catheter dwell-time, sepsis, packed red cells (PRBCs) transfusions and low platelet count were risk factors for CVC-linked thrombosis. Nevertheless, only PRBCs transfusion was significant in the multivariate analysis, with OR and 95% confidence level 5.768 (1.013-32.836). CONCLUSION Many factors should be considered in prediction of patients at risk of thrombosis including sepsis, femoral line insertion, low platelet count and PRBCs-transfusions. In our analysis, PRBCs-transfusion through peripheral intravenous lines (PIVs) was the strongest factor associated with CVC-linked thrombosis.
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Affiliation(s)
- Marwa Mohamed Farag
- The division of neonatology, Pediatric department, Faculty of medicine, Alexandria University, Alexandria, Egypt.
| | - Hesham Abd El Rahim Ghazal
- The division of neonatology, Pediatric department, Faculty of medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Masoud Radwan
- Radiodoagnosis and intervention department, Faculty of medicine, Alexandria University, Alexandria, Egypt
| | - Nada Saeid El-Sayed
- Radiodoagnosis and intervention department, Faculty of medicine, Alexandria University, Alexandria, Egypt
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Bouhafs N, Hamami A, Elouali A, Babakhouya A, Rkain M. Portal Hypertension in Children: Investigating Umbilical Catheterization in the Neonatal Period. Cureus 2024; 16:e66060. [PMID: 39224741 PMCID: PMC11367683 DOI: 10.7759/cureus.66060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
Portal cavernoma is a major cause of extrahepatic portal hypertension (EHPH) in children. It is a serious condition, due to the frequency and severity of digestive hemorrhages secondary to the rupture of esophageal varices (EV). Neonatal umbilical catheterization is a significant risk factor for the development of portal vein thrombosis (PVT) and portal hypertension. We report a case of a five-year-old male who presented with upper gastrointestinal (GI) bleeding on ruptured esophageal varices resulting from a portal cavernoma, complicating neonatal umbilical vein catheterization. This case illustrates the risk of severe vascular complications, particularly portal hypertension that can result from neonatal umbilical vein catheterization.
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Affiliation(s)
- Nadia Bouhafs
- Department of Pediatrics, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital Oujda, Oujda, MAR
| | - Amal Hamami
- Department of Pediatrics, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital Oujda, Oujda, MAR
| | - Aziza Elouali
- Department of Pediatrics, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital Oujda, Oujda, MAR
| | - Abdeladim Babakhouya
- Department of Pediatrics, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital Oujda, Oujda, MAR
| | - Maria Rkain
- Department of Pediatrics, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital Oujda, Oujda, MAR
- Pediatric Gastroenterology, Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, MAR
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Colella M, Zanin A, Toumazi A, Bourmaud A, Boizeau P, Guilmin-Crepon S, Leick N, Khat S, Alison M, Baud O, Biran V. Association between Portal Vein Thrombosis after Umbilical Vein Catheterization and Neonatal Asphyxia. Neonatology 2024; 121:478-484. [PMID: 38522417 DOI: 10.1159/000537902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Neonatal portal vein thrombosis (PVT) is frequently related to umbilical venous catheterization (UVC), but risk factors remain unclear. This study aims to analyze the variables associated to PVT in near- to full-term newborns with UVC, with a focus on newborns exposed to controlled therapeutic hypothermia (CTH) for hypoxic ischemic encephalopathy (HIE). METHODS This is retrospective cohort study of infants delivered at or after 36 weeks and with a birthweight over 1,500 g. All infants were assessed for UVC location and PVT using ultrasonography performed between day 5 and day 10 after catheterization. RESULTS Among 213 eligible patients, PVT was diagnosed in 57 (27%); among them, 54 (95%) were localized in the left portal vein branch. With all significant factors in univariate analysis considered, higher gestational age at birth (adjusted OR 1.35; 95% CI: 1.12-1.64, p = 0.002) and duration of UVC placement (adjusted OR 1.36; 95% CI: 1.11-1.67, p = 0.004) were the main risk factors of PVT. Among 87 infants who were cooled for HIE, 31 (36%) had PVT compared to 26 (21%) in infants without CTH. Using a multivariate model including variables linked to treatment procedures only, an increased PVT incidence was statistically associated with UVC duration (adjusted OR 1.33; 95% CI: 1.08; 1.63, p = 0.01) and CTH (adjusted OR 1.94; 95% CI: 1.04-3.65, p = 0.04). CONCLUSION Left PVT was frequently observed in near- to full-term neonates with UVC. Among factors linked to treatment procedures, both duration of UVC and CTH exposure for HIE were found to be independent risk factors of PVT.
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Affiliation(s)
- Marina Colella
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
- I2D2, Inserm 1141, University Paris Cité, Paris, France
| | - Anna Zanin
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
- Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Artemis Toumazi
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Aurélie Bourmaud
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Priscilla Boizeau
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Sophie Guilmin-Crepon
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Inserm U1123 and CIC-EC 1426, Paris, France
| | - Noémie Leick
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
| | - Sophea Khat
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
| | - Marianne Alison
- I2D2, Inserm 1141, University Paris Cité, Paris, France
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
| | - Olivier Baud
- I2D2, Inserm 1141, University Paris Cité, Paris, France
- Division of Neonatology and Pediatric Intensive Care, Children's University Hospital and University of Geneva, Geneva, Switzerland
| | - Valerie Biran
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Cité, Paris, France
- I2D2, Inserm 1141, University Paris Cité, Paris, France
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Lemoine CP, Yang S, Brandt KA, Carra S, Superina RA. A History of Umbilical Vein Catheterization Does Not Preclude Children from a Successful Meso-Rex Bypass. Eur J Pediatr Surg 2024; 34:28-35. [PMID: 37487509 DOI: 10.1055/s-0043-1771225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Umbilical vein catheterization (UVC) can cause portal venous thrombosis, leading to the development of extrahepatic portal venous obstruction (EHPVO) and portal hypertension (PHT). The feasibility of the Meso-Rex bypass (MRB) for the treatment of EHPVO in patients with a history of UVC has been questioned. We compared the feasibility of performing an MRB in patients with or without a history of previous UVC. METHODS A retrospective review of patients with EHPVO and known UVC status explored for a possible MRB at our institution was performed (1997-2022). Patients were categorized in two groups: with (UVC(+)) or without (UVC(-)) a history of UVC for comparison. A p-value less than 0.05 was considered significant. RESULTS One hundred and eighty-seven patients were included (n = 57 in UVC(+); n = 130 in UVC(-)). Patients in the UVC group were significantly younger at surgery and the incidence of prematurity was higher. Other risk factors for the development of EHPVO were similar between the groups, but only history of UVC could predict the ability to receive MRB (odds ratio [OR]: 7.4 [3.5-15.4]; p < 0.001). The success rate of MRB was significantly higher in patients with no history of UVC (28/57 [49.1%] in UVC(+) vs. 114/130 [87.7%] in UVC(-); p < 0.001). However, MRB patency at discharge (25/28 [89.3%] in UVC(+) vs. 106/114 [94.7%] in UVC(-); p = 0.3) was equally high in both groups. CONCLUSION Our results indicate that a history of UVC is not a contraindication to MRB. Half of the patients were able to successfully receive an MRB. Patients with symptomatic PHT from EHPVO should not be excluded from consideration for MRB based on UVC history.
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Affiliation(s)
- Caroline P Lemoine
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Stephanie Yang
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Katherine A Brandt
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Sydney Carra
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Riccardo A Superina
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
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Russo A, Patanè V, Faggioni L, Pinto A, Fusco L, Urraro F, Neri E, Reginelli A. Conventional Radiology Evaluation of Neonatal Intravascular Devices (NIVDs): A Case Series. Diagnostics (Basel) 2024; 14:157. [PMID: 38248034 PMCID: PMC10814514 DOI: 10.3390/diagnostics14020157] [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: 10/25/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Our radiology department conducted an assessment of 300 neonatal radiographs in the neonatal intensive care unit over almost two years. The purpose was to evaluate the correct positioning of intravascular venous catheters. Our case series revealed that out of a total of 95 cases with misplaced devices, 59 were umbilical venous catheters and 36 were peripherally inserted central catheters. However, all of the central venous catheters were found to be properly positioned. Misplacements of neonatal intravascular devices were found to occur more frequently than expected. The scientific literature contains several articles highlighting the potential complications associated with misplaced devices. Our goal is to highlight the potential misplacements and associated complications that radiologists may encounter while reviewing conventional radiology imaging. Based on our experience, which primarily involved placing UVCs and PICCs, we discovered that conventional radiology is the most effective method for assessing proper device placement with the lowest possible radiation exposure. Given the high number of neonatal vascular device placement procedures, it is essential for radiologists to maintain a high level of vigilance and stay updated on the latest developments in this field.
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Affiliation(s)
- Anna Russo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Lorenzo Faggioni
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy; (L.F.); (E.N.)
| | - Alessandro Pinto
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Luigia Fusco
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Emanuele Neri
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy; (L.F.); (E.N.)
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
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Valla DC. Hepatic vein thrombosis and PVT: A personal view on the contemporary development of ideas. Clin Liver Dis (Hoboken) 2024; 23:e0246. [PMID: 38988821 PMCID: PMC11236412 DOI: 10.1097/cld.0000000000000246] [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: 03/11/2024] [Accepted: 05/10/2024] [Indexed: 07/12/2024] Open
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Vrijburg M, Sari S, Koot BGP, Fijnvandraat K, Klaassen I. A high rate of post thrombotic complication in pediatric portal vein thrombosis. Thromb Res 2023; 231:44-49. [PMID: 37801774 DOI: 10.1016/j.thromres.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Portal vein thrombosis (PVT) is a rare disease in children and may be complicated by portal hypertension (PH), hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) but their incidence and risk factors are unknown. METHODS An observational, retrospective cohort study of all consecutive children (≤18 years) with PVT treated at the Emma Children's Hospital Amsterdam University Medical Centers between January 1996 and January 2022 was conducted to identify the incidence and risk factors of these post thrombotic complications (PTC) in pediatric patients. RESULTS In total 43/ 703 thrombosis patients had PVT (boys 72.1 %; mean age 1.3 ± 0.5 years). Overall, 51 % of patients developed PH (n = 22), complicated by PPHTN in one of them. In 16 of 22 patients, PVT presented with portal hypertension. Clinically relevant bleeding due to portal hypertension occurred in 13 (59.1 %) patients with PH. The mean age at the first clinically relevant bleeding was 5.1 ± 5.9 years. Risk factors for the development of PH were lack of complete thrombus resolution (OR 24.3, 95 % CI 1.2-7.0; p = 0.008) and unprovoked VTE (OR, 35.4; 95 % CI 1.4-6.3; p = 0.012). Median time from PVT to PH was 137 days (range: 0 days to 5.04 years). CONCLUSION We demonstrated that half of the patients develop PH after PVT, with a lack of thrombus resolution and unprovoked VTE as independent risk factors. This high incidence underlines the importance of long-term standardized follow-up of patients after PVT and standard screening in patients at risk of PTC.
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Affiliation(s)
- M Vrijburg
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - S Sari
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - B G P Koot
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilm Klaassen
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Kim MJ, Yoo SY, Jeon TY, Kim JH, Kim YJ. Imaging of Umbilical Venous Catheter-Related Hepatic Complications in Neonates. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:586-595. [PMID: 37324991 PMCID: PMC10265250 DOI: 10.3348/jksr.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
An umbilical venous catheter (UVC) is commonly placed for central venous access in preterm or critically ill full-term neonates to provide total parenteral nutrition (TPN) and medication. However, UVCs can result in complications, including infection, portal vein thrombosis, and hepatic tissue injury. The inadvertent administration of hypertonic fluid through a malpositioned UVC can also cause hepatic parenchymal damage with mass-like fluid collection that simulates a tumorous condition during imaging. Ultrasonography and radiographic examinations play an essential role in detecting UVC-related complications. This pictorial essay aims to present the imaging findings of UVC-related hepatic complications in neonates.
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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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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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Betensky M, Kulkarni K, Rizzi M, Jones S, Brandão LR, Faustino EVS, Goldenberg NA, Sharathkumar A. Recommendations for standardized definitions, clinical assessment, and future research in pediatric clinically unsuspected venous thromboembolism: Communication from the ISTH SSC subcommittee on pediatric and neonatal thrombosis and hemostasis. J Thromb Haemost 2022; 20:1729-1734. [PMID: 35570328 PMCID: PMC9324216 DOI: 10.1111/jth.15731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
Clinically unsuspected venous thromboembolism (VTE) in children is defined as a VTE diagnosed via imaging test performed for surveillance (i.e., with an intent to identify clinically silent VTEs) or incidentally found (most often via imaging performed for evaluation of regional pathology unrelated to VTE) in the absence of any VTE-associated signs or symptoms. Our understanding of the clinical significance of these events in children is limited by a paucity of data on the epidemiology and outcomes of this complication. There is an urgent need for further research in this area to inform optimal management. Recognizing this knowledge gap, this Task Force has previously published a systematic review of the literature in this topic. We now provide guidance recommendations for standardization of definitions and identify future research needs on clinically unsuspected VTE in children. These recommendations will serve to enhance the quantity and quality of evidence on the topic and facilitate the design and execution of cooperative observational studies, and interventional trials of risk-stratified management approaches aimed at preventing and optimizing long-term outcomes of clinically unsuspected VTE in children.
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Affiliation(s)
- Marisol Betensky
- Department of PediatricsDivision of HematologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Institute of Clinical and Translational ResearchJohns Hopkins All Children’s HospitalSt. PetersburgFloridaUSA
| | - Ketan Kulkarni
- Department of PediatricsDivision of Hematology‐OncologyIWK Health CentreHalifaxNSCanada
| | - Mattia Rizzi
- Pediatric Hematology/Oncology UnitDepartment of Woman‐Mother‐ChildUniversity Hospital CHUVLausanneSwitzerland
| | - Sophie Jones
- Department of NursingThe University of MelbourneMelbourneVic.Australia
- Department of Clinical HaematologyThe Royal Children's HospitalMelbourneVic.Australia
| | - Leonardo R. Brandão
- Division of Haematology/OncologyDepartment of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | | | - Neil A. Goldenberg
- Institute of Clinical and Translational ResearchJohns Hopkins All Children’s HospitalSt. PetersburgFloridaUSA
- Department of Medicine and PediatricsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Anjali Sharathkumar
- Stead Family Department of PediatricsUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
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Gurel S, Gözen A, Bektas MS. Central Subclavian Catheterization in Newborns: Single-Center Experience. JOURNAL OF CHILD SCIENCE 2022. [DOI: 10.1055/s-0041-1741425] [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
AbstractOur main aim of this article was to show that central venous catheter (CVC) can be an easy-to-use, less-complicated catheter application such as peripherally inserted central catheter and umbilical catheter placement in the neonatal intensive care unit. We here described our experience with subclavian vein catheterization. Neonates who had venous access through subclavian central catheterization were assessed retrospectively. Data such as gestational age, age at the time of catheter insertion, birth weight, and gender were collected. In addition, problems related to catheterization during hospitalization were documented. This study comprised 40 newborns, 22 male and 18 female, with a mean gestational week of 29.57 ± 3.80 weeks and a mean gestational weight of 2067.50 ± 545.97 g. Due to occlusion, catheters were switched in five cases twice and in three cases once, totaling 53 catheterizations on 40 newborns. None of our patients had pneumothorax or hemothorax. On the postoperative 8th and 21st days, the catheter was withdrawn due to catheter infection in two (5%) patients, and catheter cultures revealed coagulase negative Staphylococcus aureus in both cases. Even in preterm infants, subclavian central venous catheterization is a safe and straightforward technique of gaining venous access in expert hands in the neonatal intensive care unit.
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Affiliation(s)
- Selcuk Gurel
- Department of Pediatrics, Oztan Hospital, Usak, Turkey
| | - Ahmet Gözen
- Department of Pediatric Surgery, Lokman Hekim Van Hospital, Van, Turkey
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Kiblawi R, Zoeller C, Pirr S, Hofmann AD, Ure B, Dingemann J. Vena Cava Thrombosis after Congenital Diaphragmatic Hernia Repair: Multivariate Analysis of Potential Risk Factors. Eur J Pediatr Surg 2022; 32:91-97. [PMID: 34891190 DOI: 10.1055/s-0041-1740462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The treatment of newborns with congenital diaphragmatic hernia (CDH) is associated with a significant complication rate. Information on major thrombotic complications and their incidence in newborns with CDH is lacking. The aims of our analysis were to evaluate the frequency of vena cava thrombosis and to determine its predictors within a consecutive series of patients with CDH. MATERIALS AND METHODS We retrospectively analyzed charts of all neonates of our department that underwent CDH repair from 2007 to 2021, focusing on vena cava thrombosis. Vena cava thrombosis was diagnosed sonographically and classified as complete or partial venous occlusion. Complete occlusion was confirmed by cavography. Variables evaluated were CDH side, liver position, central vein line, surgical approach, and extracorporeal membrane oxygenation (ECMO). Univariate and multivariate tests were utilized. RESULTS Among 57 neonates who underwent CDH repair, vena cava thrombosis was diagnosed in 14 (24.6%), seven of whom had complete occlusion of the vena cava. Factors associated with vena cava thrombosis were femoral or saphenous venous catheter (p = 0.044), right sided CDH (p = 0.027) and chylothorax (p < 0.0001). ECMO was not associated with vena cava thrombosis. Seven patients (50%) with vena cava thrombosis were treated interventionally with angioplasty and seven (50%) conservatively with anticoagulation only. Mortality was not higher in patients with compared with patients without vena cava thrombosis. CONCLUSION The incidence of vena cava thrombosis in newborns with CDH in our series is high. Routine postoperative abdominal sonography focusing on vena cava thrombosis is mandatory in all patients with CDH. Patients who developed vena cava thrombosis were more likely to develop chylothorax after CDH repair. Considering the good outcome of medical therapy of partial vena cava thrombosis, it may be discussed whether low dose anticoagulation may be provided to all newborns with CDH.
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Affiliation(s)
- Rim Kiblawi
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Christoph Zoeller
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany.,Department of Pediatric Surgery, University Hospital Muenster, Muenster, Germany
| | - Sabine Pirr
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Alejandro D Hofmann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
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14
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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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15
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Bersani I, Piersigilli F, Iacona G, Savarese I, Campi F, Dotta A, Auriti C, Di Stasio E, Garcovich M. Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis. World J Hepatol 2021; 13:1802-1815. [PMID: 34904047 PMCID: PMC8637679 DOI: 10.4254/wjh.v13.i11.1802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of umbilical venous catheters (UVCs) in the perinatal period may be associated with severe complications, including the occurrence of portal vein thrombosis (PVT).
AIM To assess the incidence of UVC-related PVT in infants with postnatal age up to three months.
METHODS A systematic and comprehensive database searching (PubMed, Cochrane Library, Scopus, Web of Science) was performed for studies from 1980 to 2020 (the search was last updated on November 28, 2020). We included in the final analyses all peer-reviewed prospective cohort studies, retrospective cohort studies and case-control studies. The reference lists of included articles were hand-searched to identify additional studies of interest. Studies were considered eligible when they included infants with postnatal age up to three months with UVC-associated PVT. Incidence estimates were pooled by using random effects meta-analyses. The quality of included studies was assessed using the Newcastle-Ottawa scale. The systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.
RESULTS Overall, 16 studies were considered eligible and included in the final analyses. The data confirmed the relevant risk of UVC-related thrombosis. The mean pooled incidence of such condition was 12%, although it varied across studies (0%-49%). In 15/16 studies (94%), diagnosis of thrombosis was made accidentally during routine screening controls, whilst in 1/16 study (6%) targeted imaging assessments were carried out in neonates with clinical concerns for a thrombus. Tip position was investigated by abdominal ultrasound (US) alone in 1/16 (6%) studies, by a combination of radiography and abdominal US in 14/16 (88%) studies and by a combination of radiography, abdominal US and echocardiography in 1/16 (6%) studies.
CONCLUSION To the best of our knowledge, this is the first systematic review specifically investigating the incidence of UVC-related PVT. The use of UVCs requires a high index of suspicion, because its use is significantly associated with PVT. Well-designed prospective studies are required to assess the optimal approach to prevent UVC-related thrombosis of the portal system.
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Affiliation(s)
- Iliana Bersani
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Fiammetta Piersigilli
- Department of Neonatology, Cliniques Universitaires Saint Luc, Universitè Catholique de Louvain, Bruxelles 1200, Belgium
| | - Giulia Iacona
- Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Immacolata Savarese
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Francesca Campi
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Andrea Dotta
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Cinzia Auriti
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Enrico Di Stasio
- Department of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Matteo Garcovich
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- CEMAD Digestive Disease Center, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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16
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Grama A, Pîrvan A, Sîrbe C, Burac L, Ştefănescu H, Fufezan O, Bordea MA, Pop TL. Extrahepatic Portal Vein Thrombosis, an Important Cause of Portal Hypertension in Children. J Clin Med 2021; 10:2703. [PMID: 34207387 PMCID: PMC8235032 DOI: 10.3390/jcm10122703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023] Open
Abstract
One of the most important causes of portal hypertension among children is extrahepatic portal vein thrombosis (EHPVT). The most common risk factors for EHPVT are neonatal umbilical vein catheterization, transfusions, bacterial infections, dehydration, and thrombophilia. Our study aimed to describe the clinical manifestations, treatment, evolution, and risk factors of children with EHPVT. METHODS We analyzed retrospectively all children admitted and followed in our hospital with EHPVT between January 2011-December 2020. The diagnosis was made by ultrasound or contrast magnetic resonance imaging. We evaluated the onset symptoms, complications, therapeutic methods, and risk factors. RESULTS A total of 63 children, mean age 5.14 ± 4.90 (33 boys, 52.38%), were evaluated for EHPVT during the study period. The first symptoms were upper gastrointestinal bleeding (31 children, 49.21%) and splenomegaly (22 children, 34.92%). Thrombocytopenia was present in 44 children (69.84%). The most frequent risk factors were umbilical vein catheterization (46 children, 73.02%) and bacterial infections during the neonatal period (30 children, 47.62%). Protein C, protein S, antithrombin III levels were decreased in 44 of the 48 patients tested. In 42 of these cases, mutations for thrombophilia were tested, and 37 were positive. Upper digestive endoscopy was performed in all cases, revealing esophageal varices in 56 children (88.89%). All children with gastrointestinal bleeding received an octreotide infusion. In 26 children (41.27%), variceal ligation was performed, and in 5 children (7.94%), sclerotherapy. Porto-systemic shunt was performed in 11 children (17.46%), and Meso-Rex shunt was done in 4 children (6.35%). The evolution was favorable in 62 cases (98.41%). Only one child died secondary to severe sepsis. CONCLUSIONS EHPVT is frequently diagnosed in the last period in our region due to the increased use of umbilical vein catheterization. Furthermore, genetic predisposition, neonatal bacterial infections, and prematurity certainly play an important role in this condition. A proactive ultrasound assessment of children with risk factors for EHPVT should be encouraged for early diagnosis and treatment.
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Affiliation(s)
- Alina Grama
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
| | - Alexandru Pîrvan
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
| | - Claudia Sîrbe
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
| | - Lucia Burac
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
| | - Horia Ştefănescu
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
- Liver Research Club, 400162 Cluj-Napoca, Romania
| | - Otilia Fufezan
- Department of Imaging, Emergency Clinical Hospital for Children, 400078 Cluj-Napoca, Romania;
| | - Mădălina Adriana Bordea
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania;
| | - Tudor Lucian Pop
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
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17
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Seber T. A fern frond-like peripheral portal vein thrombosis in a neonate: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:274-276. [PMID: 32869343 DOI: 10.1002/jcu.22900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
Although the ultrasonographic (US) features of portal vein thrombosis in premature newborns have been described, there are very few reports on thrombosis of the peripheral branches of the portal vein. Here, I describe a case of peripheral portal vein branch thrombosis in a neonate, appearing on US imaging with a fern frond pattern.
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18
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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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19
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Duerden EG, Grunau RE, Chau V, Groenendaal F, Guo T, Chakravarty MM, Benders M, Wagenaar N, Eijsermans R, Koopman C, Synnes A, Vries LD, Miller SP. Association of early skin breaks and neonatal thalamic maturation: A modifiable risk? Neurology 2020; 95:e3420-e3427. [PMID: 33087497 DOI: 10.1212/wnl.0000000000010953] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/17/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To test the hypothesis that a strategy of prolonged arterial line (AL) and central venous line (CVL) use is associated with reduced neonatal invasive procedures and improved growth of the thalamus in extremely preterm neonates (<28 weeks' gestation). METHODS Two international cohorts of very preterm neonates (n = 143) with prolonged (≥14 days) or restricted (<14 days) use of AL/CVL were scanned serially with MRI. General linear models were used to determine the association between skin breaks and thalamic volumes, accounting for clinical confounders and site differences. Children were assessed at preschool age on standardized tests of motor and cognitive function. Outcome scores were assessed in relation to neonatal thalamic growth. RESULTS Prolonged AL/CVL use in neonates (n = 86) was associated with fewer skin breaks (median 34) during the hospital stay compared to restricted AL/CVL use (n = 57, median 91, 95% confidence interval [CI] 60.35-84.89). Neonates with prolonged AL/CVL use with fewer skin breaks had significantly larger thalamic volumes early in life compared to neonates with restricted line use (B = 121.8, p = 0.001, 95% CI 48.48-195.11). Neonatal thalamic growth predicted preschool-age cognitive (B = 0.001, 95% CI 0.0003-0.001, p = 0.002) and motor scores (B = 0.01, 95% CI 0.001-0.10, p = 0.02). Prolonged AL/CVL use was not associated with greater incidence of sepsis or multiple infections. CONCLUSIONS Prolonged AL/CVL use in preterm neonates may provide an unprecedented opportunity to reduce invasive procedures in preterm neonates. Pain reduction in very preterm neonates is associated with optimal thalamic growth and neurodevelopment.
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Affiliation(s)
- Emma G Duerden
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Ruth E Grunau
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Vann Chau
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Floris Groenendaal
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Ting Guo
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - M Mallar Chakravarty
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Manon Benders
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Nienke Wagenaar
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Rian Eijsermans
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Corine Koopman
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Anne Synnes
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Linda de Vries
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada
| | - Steven P Miller
- From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada.
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20
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van Els AL, Israëls J, van Houten MA, de Meij TGJ. Hematemesis in an eight-year-old female as a presenting symptom of portal vein thrombosis following neonatal umbilical vein catheterization. Pediatr Neonatol 2020; 61:663-664. [PMID: 32641275 DOI: 10.1016/j.pedneo.2020.06.004] [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: 12/02/2019] [Revised: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anne Louise van Els
- Department of Paediatrics, AUMC, Location VU University Medical Center, Amsterdam, the Netherlands; Department of Pediatric Gastroenterology, AUMC, Location VU University Medical Center, Amsterdam, the Netherlands.
| | - Joël Israëls
- Department of Paediatrics, AUMC, Location VU University Medical Center, Amsterdam, the Netherlands; Department of Pediatric Gastroenterology, AUMC, Location VU University Medical Center, Amsterdam, the Netherlands
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21
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Born M. The Ductus Venosus. ROFO-FORTSCHR RONTG 2020; 193:521-526. [PMID: 33152783 DOI: 10.1055/a-1275-0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND the ductus venosus (DV) is not well known in general radiology, but it plays a role in the daily work of pediatric radiologists. Consequently all general radiologists who also care for a pediatric department should be familiar with the physiological and pathological findings related to the DV. METHODS Literature research in Medline, using the keywords "ductus venosus" and "umbilical vein catheter". RESULTS AND CONCLUSIONS In the first weeks of life the DV is regularly still patent. It should be recognized as DV and not be mistaken for a pathological portosystemic shunt.The ductus venosus is the lead structure for umbilical vein catheters. Radiologists should be able to assess the correct catheter position. Radiologically important findings of an umbilical vein catheter are mainly malposition and intrahepatic extravasation. Agenesis of the DV can lead to intra- or extrahepatic compensatory portosystemic shunts, in which as well as in the case of persistent patency of the DV, there may be the necessity for radiological-interventional or surgical occlusion. KEY POINTS · In the first weeks of life in infants the Ductus venosus is regularly still patent.. · The Ductus venosus should not be mistaken for a pathological portosystemic shunt.. · An umbilcal vein catheter should project onto the Ductus venosus and end caudal to the right atrium.. · Intrahepatic portosystemic shunts in DV agenesis show a high rate of spontaneous closure postnatally.. CITATION FORMAT · Born M. The Ductus Venosus. Fortschr Röntgenstr 2021; 193: 521 - 526.
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Affiliation(s)
- Markus Born
- Department of Radiology, Division of Pediatric Radiology, University Hospital Bonn, Germany
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22
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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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Heurgué A, Habes D, Brugel M, Franchi-Abella S, Condat B, Valla D, Hillaire S, Debray D, Hernandez-Gea V, Dutheil D, Plessier A, Bureau C, Payancé A. Recent (non-cirrhotic) extrahepatic portal vein obstruction. Clin Res Hepatol Gastroenterol 2020; 44:460-465. [PMID: 32448586 DOI: 10.1016/j.clinre.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Alexandra Heurgué
- Department of Gastroenterology and Hepatology, Robert Debré Hospital, University Hospital of Reims, avenue du Général-Koening, 51092 Reims cedex, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Dalila Habes
- Department of Pediatric Hepatology, Bicêtre Hospital, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Mathias Brugel
- Department of Gastroenterology and Hepatology, Robert Debré Hospital, University Hospital of Reims, avenue du Général-Koening, 51092 Reims cedex, France
| | - Stéphanie Franchi-Abella
- Department of Pediatric Radiology, Bicêtre Hospital, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Bertrand Condat
- Department of Gastroenterology, Hospital of French Polynesia, BP 1640 Papeete, 98 713 Tahiti, French Polynesia; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Dominique Valla
- Department of Hepatology and reference center of vascular liver diseases, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Sophie Hillaire
- Department of Internal Medicine, Foch Hospital, 40, rue Worth, 92150 Suresnes, France
| | - Dominique Debray
- Department of Pediatric Hepatology, Hôpital Necker - enfants maladies, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Virginia Hernandez-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Health Care Provider of the European Reference Network onRare Liver Disorders (ERN-Liver), Spain
| | - Danielle Dutheil
- Department of Hepatology, Association of patients with vascular liver diseases (AMVF), Beaujon Hospital, 100, boulevard du Général-Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Aurélie Plessier
- Department of Hepatology and reference center of vascular liver diseases, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Reference center of vascular liver diseases, European Reference Network (ERN) "Rare-Liver", Beaujon Hospital, Clichy, France
| | - Christophe Bureau
- Department of Gastroenterology and Hepatology, Rangueil Hospital, University Hospital of Toulouse, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Audrey Payancé
- Department of Hepatology and reference center of vascular liver diseases, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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El-Naggar W, Yoon EW, McMillan D, Afifi J, Mitra S, Singh B, da Silva O, Lee SK, Shah PS. Epidemiology of thrombosis in Canadian neonatal intensive care units. J Perinatol 2020; 40:1083-1090. [PMID: 32385393 DOI: 10.1038/s41372-020-0678-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/06/2020] [Accepted: 04/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the rate, location, risk factors, management, and outcomes of neonatal thrombosis (NT). DESIGN A retrospective study investigating infants admitted to NICUs in Canadian Neonatal Network between January 2014 and December 2016 and diagnosed with NT. Each infant with NT was matched with an infant without NT. RESULTS Of 39,971 infants, 587 (1.5%) were diagnosed with NT: 440 (75%) venous, 112 (19%) arterial, 29 (5%) both. NT rate was 1.4% in full-term and 1.7% in preterm infants. Venous thrombi occurred most commonly in the portal vein and arterial thrombi in the cerebral artery. Conservative management and low molecular weight heparin were the most common treatment modalities. Hospital stay was longer (p < 0.001) in the NT patients, but mortality was similar. CONCLUSIONS NT was diagnosed in ~15/1000 NICU admissions and most commonly in the portal vein and cerebral arteries. Management varied based on the type and location of thrombi. Large multicenter trials are needed to address the best management strategies.
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Affiliation(s)
- Walid El-Naggar
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
| | - Eugene W Yoon
- Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Douglas McMillan
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Jehier Afifi
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Souvik Mitra
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Balpreet Singh
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Orlando da Silva
- Department of Pediatrics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Shoo K Lee
- Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Totonto, ON, Canada
| | - Prakesh S Shah
- Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
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25
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Sharathkumar AA, Biss T, Kulkarni K, Ahuja S, Regan M, Male C, Revel-Vilk S. Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review. J Thromb Haemost 2020; 18:1100-1112. [PMID: 31984669 PMCID: PMC7192773 DOI: 10.1111/jth.14739] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. Unsuspected VTE are often referred as "asymptomatic," "incidental," or "clinically silent/occult" VTE. OBJECTIVE To understand the epidemiology, management, and outcomes of uVTE in children. METHODS A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤ 21 years). RESULTS Among 10 875 articles, 51 studies (8354 children with 758 uVTE) were selected. The studies were heterogeneous, I2 96%; P < .0001. Unsuspected VTE were diagnosed in two settings: first, asymptomatic VTE (aVTE) diagnosed through surveillance imaging for VTE (46 studies; n = 5894; aVTE: 715, pooled frequency: 19%, 95% confidence interval [CI]: 13%-24%); second, incidental VTE (iVTE) diagnosed during imaging performed for indications without primary suspicion for VTE (6 studies; n = 2460; iVTE: 43). The majority (94%) of aVTE were associated with central venous lines (CVL). Non-CVL settings included post-spinal surgery, post-splenectomy, trauma, nephrotic syndrome, and newborns. In general, aVTE were reported to have a benign clinical course, were mostly transient, and resolved without intervention and with few immediate or long-term functional complications. Incidental VTE were primarily detected in children with cancer and ranged from tumor-associated thrombi to pulmonary embolism (PE) with insufficient evidence to draw meaningful conclusions about their management. CONCLUSION Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and thromboprophylaxis. Prospective research is needed to clarify the optimal management of iVTE.
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Affiliation(s)
- Anjali A. Sharathkumar
- Stead Family Department of Pediatrics, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Tina Biss
- Department of Pediatrics, Royal Victoria Infirmary, UK
| | | | - Sanjay Ahuja
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre and Dalhousie University, Canada
| | | | - Christoph Male
- Department of Paediatrics, Medical University of Vienna, Austria
| | - Shoshana Revel-Vilk
- Pediatric Hematology/Oncology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
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26
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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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27
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Risk factors for peripherally inserted central catheter complications in neonates. J Perinatol 2020; 40:581-588. [PMID: 31911643 DOI: 10.1038/s41372-019-0575-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine factors associated with nonelective PICC removal and complications. STUDY DESIGN Overall, 1234 PICCs were placed in 918 hospitalized infants <45 weeks postmenstrual age. Outcomes studied include nonelective PICC removal (removal prior to completion of therapy) and line complications. Univariate and multivariate mixed-effects logistic regression analyses were conducted to evaluate the associations between potential predictor variables and clinical outcomes RESULTS: Nonelective PICC removal occurred in 28.4% and complications in 34.4% of infants. Nonelective removal (p < 0.001) and complications (p = 0.006) occurred more often with upper than lower extremity PICCs. Malposition in the first 72 h (p = 0.0009) and over time (p = 0.0003) were more common in upper extremity PICCS; however, upper extremity PICCs were associated with a decreased incidence of phlebitis, edema, and perfusion changes (p = 0.03). CONCLUSIONS Approximately one-third of PICCs were associated with complications. When feasible, lower extremity PICCs should be placed as they may be associated with fewer complications.
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28
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Bhat R, Monagle P. Anticoagulation in preterm and term neonates: Why are they special? Thromb Res 2020; 187:113-121. [DOI: 10.1016/j.thromres.2019.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 01/19/2023]
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29
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Imaging of the intrahepatic portal vein in children with extrahepatic portal vein thrombosis - Comparison of magnetic resonance imaging and retrograde portography. J Pediatr Surg 2019; 54:1686-1690. [PMID: 30497819 DOI: 10.1016/j.jpedsurg.2018.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Extrahepatic portal vein thrombosis (EPVT) is one major cause of portal hypertension in children. Surgical reinstallation of portal venous flow can be achieved in patients with patent intrahepatic portal venous system/Rex recess. Our study aimed to compare the ability of magnetic resonance imaging (MRI) and retrograde portography (RP) to assess patency of the intrahepatic portal venous system in children with EPVT. METHODS All pediatric patients with EPVT who were examined with contrast enhanced MRI (1.5 T) and invasive RP between 2013 and 2017 were included in this retrospective study. Medical records were reviewed for demographic, biochemical and clinical data. Patency of the Rex recess as detected by MRI and RP was retrospectively reviewed. RESULTS Sixteen children (7.6 ± 5.0 years) with EPVT were included. Sensitivity, specificity, positive and negative predictive value for the detection of patent Rex recess by MRI compared to RP were 55%, 57%, 63% and 50%. Diagnostic accuracy was 56%. Diagnostic failure of MRI compared to RP was explained by the following: I. Problems differentiating collaterals from portal venous vessels II. Incapability showing dynamic blood flow in compromised portal venous flow III. Poor spatial resolution, especially in small children. CONCLUSION RP is a reliable method for the visualization of the Rex recess and the intrahepatic portal venous system in children with EPVT, whereas MRI has shown to be unsuitable for the assessment of the intrahepatic portal vein in these patients. In the preoperative setup, we recommend both procedures, RP and MRI for the visualization of the intrahepatic portal venous system, and the extrahepatic vessels, respectively. LEVEL OF EVIDENCE Level III.
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30
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Hargitai B, Toldi G, Marton T, Ramalingam V, Ewer AK, Bedford Russell AR. Pathophysiological Mechanism of Extravasation via Umbilical Venous Catheters. Pediatr Dev Pathol 2019; 22:340-343. [PMID: 30683018 DOI: 10.1177/1093526619826714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A rare complication of umbilical venous catheter (UVC) insertion is the extravasation of the infusate into the peritoneal cavity. We report 3 cases of abdominal extravasation of parenteral nutrition (PN) fluid via UVCs. Two of these cases presented as "acute abdomen" which were assumed to be necrotizing enterocolitis clinically; however, during postmortem, PN ascites and liver necrosis were found. A further case is described in an infant with congenital diaphragmatic hernia. While we were unable to ascertain direct vessel perforation by the catheter in any of these cases, based on pathological and histological examination, the proposed mechanism of PN fluid extravasation is leakage through microinjuries of liver vessel walls and necrotic parenchyma. PN extravasation should be considered as a differential diagnosis of acute abdomen when PN is infused via an UVC presumably as PN may have a direct irritant effect on the peritoneum.
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Affiliation(s)
- Beata Hargitai
- 1 Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Gergely Toldi
- 2 Neonatal Unit, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Tamas Marton
- 1 Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Velmurugan Ramalingam
- 2 Neonatal Unit, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Andrew K Ewer
- 2 Neonatal Unit, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Alison R Bedford Russell
- 2 Neonatal Unit, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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31
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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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32
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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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33
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Hoellering A, Tshamala D, Davies MW. Study of movement of umbilical venous catheters over time. J Paediatr Child Health 2018; 54:1329-1335. [PMID: 29806878 DOI: 10.1111/jpc.14073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/15/2018] [Accepted: 04/25/2018] [Indexed: 12/21/2022]
Abstract
AIM To quantify, in well-positioned umbilical venous catheters (UVC), the direction and magnitude of catheter tip migration. METHODS In this prospective, single-centre, observational, cohort study, infants with a UVC inserted that reached the target zone - inferior vena cava, from ductus venosus to cavoatrial junction (CAJ) - were included. Ultrasound was used to position the catheter tip as near to the CAJ as possible at insertion and to guide any subsequent withdrawals of the catheter. Radiographs and ultrasound were repeated the day following the insertion of the UVC and on any day following adjustment. A final scan was performed on the day of catheter removal. The anatomical position of the catheter and its distance from the CAJ was recorded with each scan. RESULTS The study ran from May 2015 to August 2016 in the neonatal unit at the Royal Brisbane and Women's Hospital. Thirty-eight patients were recruited, but 18 failed to negotiate the ductus venosus. For the remaining 20, the initial UVC position was within 3 mm of the CAJ on ultrasound. Subsequently, on day 2, 25% of catheters were well positioned, 65% were high and 10% were below the target zone. On the late scan prior to UVC removal, 90% of catheters had migrated from their position on the preceding scan: outward migration in 80% of cases ranging from 2 to 23 mm (median 8.5 mm). Only 35% of catheters remained well positioned. CONCLUSION The majority of UVCs migrate over time, usually inwards initially and then outwards to a low position.
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Affiliation(s)
- Adam Hoellering
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Didier Tshamala
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Newborn Intensive Care Unit, Mater Mother's Newborn Care Services, Brisbane, Queensland, Australia
| | - Mark W Davies
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
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34
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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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Aluloska N, Janchevska S, Tasic V. Non Catether Induced Renal and Inferior Vena Cava Trombosis in a Neonate: A Case Report. Open Access Maced J Med Sci 2018; 6:1678-1681. [PMID: 30337987 PMCID: PMC6182507 DOI: 10.3889/oamjms.2018.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Neonatal renal vein thrombosis is the most common vascular condition in the newborn kidney, which could lead to serious complication in infants. CASE REPORT: We report a case of the unilateral renal vein and inferior vena cava thrombosis, presented with gross hematuria and thrombocytopenia in a neonate. The neonate was a macrosomic male born to a mother with hyperglycemia in pregnancy. The baby was born with perinatal asphyxia and early neonatal infection and massive hematuria. Clinical and laboratory examination showed enlarged kidney having corticomedullary differentiation diminished and azotemia. Diagnosis of renal vein thrombosis was suspected by renal ultrasound and confirmed by magnetic urography. Prothrombotic risk factors were evaluated. The child is being managed conservatively. Measures aimed at the prevention of end-stage renal disease because of its poor outcome were highlighted. Despite anticoagulant therapy, the right kidney developed areas of scarring and then atrophy. CONCLUSION: In this work, we present a patient with multiple entities in the aetiology of non-catheter induced renal and vena cava thrombosis in a neonate. Clinicians should suspect renal vein thrombosis in neonates when presented with early postnatal gross hematuria, palpable abdominal mass and thrombopenia.
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Affiliation(s)
- Natasha Aluloska
- Neonatology Department, University Children Hospital, Skopje, Republic of Macedonia
| | - Snezana Janchevska
- NICU, University Clinic for Gynecology and Obstetrics, Skopje, Republic of Macedonia
| | - Velibor Tasic
- Nephrology Department, University Children Hospital, Skopje, Republic of Macedonia
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Levine E, Beroul N, Cortey A, Damais Cepitelli A, Gouezec H, Pujol S, Wibaut B, Marti B. [Blood transfusion in neonatology: Study of practical aspects in 2016 in France, excluding acute bleeding or surgical care]. Transfus Clin Biol 2018; 25:249-256. [PMID: 30193925 DOI: 10.1016/j.tracli.2018.08.005] [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: 07/28/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Blood transfusion is common in neonatology, especially in preterm or low birth weight infants. Recommendations were proposed by the French National Authority of Health (HAS) in 2014 and 2015 for red blood cells and platelet transfusion respectively, but an heterogeneity of practical attitudes persist. The objective of this survey is to evaluate transfusion practices in neonatal intensive care units. METHODS Investigation of practice of neonatal transfusion was organized among 68 neonatal intensive care unit (level 3) between September 2016 and May 2017, by mailing survey focused on systematic training of nurses, patient identification, immunohematology, information and technical aspects of blood components administration. RESULTS Twenty-three neonatal intensive care units among the 68s answered the questionnaire. One thousand five hundred sixty seven neonates were transfused and 3382 blood products were administered. The results highlight a consensual attitude concerning the procedures of patient identification, immunohematology tests and blood products administration. However, heterogeneity remains concerning information of the parents or the person with parental authority, immediate and delayed follow-up and devices used for the transfusion. However HAS guidelines (2014 and 2015) appear to be well applied by clinicians for blood products, specifications and calcul of transfused volume based on gestational age and weight.
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Affiliation(s)
- E Levine
- Service de néonatologie, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | - N Beroul
- Centre national de référence en hémobiologie périnatale, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Cortey
- Centre national de référence en hémobiologie périnatale, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Damais Cepitelli
- Unité d'hémovigilance, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France
| | - H Gouezec
- Hôpital Pontchaillou, CHU de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - S Pujol
- CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - B Wibaut
- Pôle d'hémobiologie transfusion, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - B Marti
- Agence régionale de santé Nouvelle-Aquitaine, 103, bis rue Belleville, CS 91704, 33063 Bordeaux cedex, France
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Derinkuyu BE, Boyunaga OL, Damar C, Unal S, Ergenekon E, Alimli AG, Oztunali C, Turkyilmaz C. Hepatic Complications of Umbilical Venous Catheters in the Neonatal Period: The Ultrasound Spectrum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1335-1344. [PMID: 29034490 DOI: 10.1002/jum.14443] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Umbilical venous catheterization is commonly used in the neonatal period; however, it has some complications. In this study, we evaluated neonates who underwent umbilical venous catheterization and developed hepatic complications. Furthermore, we aimed to define all of the possible lesions and to clarify the imaging findings of umbilical venous catheter-induced hepatic injury. METHODS Two hundred forty-four neonates who underwent umbilical venous catheterization between March 2013 and September 2015 in a single tertiary care referral center were included in this study. To determine whether they had any hepatic complications, all patients underwent abdominal grayscale and Doppler ultrasound examinations, and their clinical data were recorded. RESULTS The frequency of liver-related complications from umbilical venous catheterization was 33.6% (82 of 244). Air in the portal venous system was the most frequent complication (20.1% [49 of 244]). Left portal venous thrombosis was noted in 6.1% (15 of 244). Parenchymal lesions in the liver related to umbilical venous catheterization were seen in 7.4% of patients (18 of 244) as follows: single nodular echogenic lesions (4.1% [10 of 244]), branching small nodular echogenic lesions (2.1% [5 of 244]), and large irregular heterogeneous lesions with laceration and perihepatic fluid (1.2% [3 of 244]). There was no statistical significance for any type of complication according to the gestational age (P > .05). CONCLUSIONS Hepatic complications due to umbilical venous catheters are not uncommon in the neonatal period. Ultrasound is the best imaging modality for confirming the diagnosis and for follow-up.
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Affiliation(s)
- Betul Emine Derinkuyu
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Oznur Leman Boyunaga
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cagri Damar
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sezin Unal
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Ergenekon
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Gul Alimli
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cigdem Oztunali
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Canan Turkyilmaz
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Duration to Establish an Emergency Vascular Access and How to Accelerate It: A Simulation-Based Study Performed in Real-Life Neonatal Resuscitation Rooms. Pediatr Crit Care Med 2018; 19:468-476. [PMID: 29432404 DOI: 10.1097/pcc.0000000000001508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation. DESIGN Retrospective analysis of audio-video recorded neonatal simulation training. SETTINGS Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany). Equipment was prepared the same way as for real clinical events. SUBJECTS Medical teams of four to five persons with birth-related background (midwives, nurses, neonatologists, and anesthesiologists) in a realistic team composition. INTERVENTIONS Audio-video recorded mannequin-based simulated resuscitation of an asphyxiated newborn including the establishment of either umbilical venous catheter or intraosseous access. MEASUREMENTS AND MAIN RESULTS The duration of access establishment (time from decision to first flush/aspiration), preparation (decision to start of procedure), and the procedure itself (start to first flush/aspiration) was significantly longer for umbilical venous catheter than for intraosseous access (overall duration 199 vs 86 s). Delaying factors for umbilical venous catheter establishment were mainly due to the complex approach itself, the multitude of equipment required, and uncertainties about necessary hygiene standards. Challenges in intraosseous access establishment were handling of the unfamiliar material and absence of an intraosseous access kit in the resuscitation room. There was no significant difference between the required duration for access establishment between large centers and small hospitals, but a trend was observed that duration for umbilical venous catheter was longer in small hospitals than in centers. Duration for intraosseous access was similar in both hospital types. CONCLUSIONS Vascular access establishment in neonatal resuscitation could be accelerated by infrastructural improvements and specific training of medical teams. In simulated in situ neonatal resuscitation, intraosseous access is faster to establish than umbilical venous catheter. Future studies are required to assess efficacy and safety of both approaches in real resuscitation settings.
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Femoral Vein Catheter is an Important Risk Factor for Catheter-related Thrombosis in (Near-)term Neonates. J Pediatr Hematol Oncol 2018; 40:e64-e68. [PMID: 29016413 DOI: 10.1097/mph.0000000000000978] [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] [Indexed: 11/25/2022]
Abstract
Central venous catheters (CVCs) in neonates are associated with an increased risk of thrombosis. Most reports focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs), whereas data available on femoral venous catheters (FVCs) are limited. We performed a retrospective cohort study in all neonates (gestational age ≥34 wk) with CVCs. The primary outcome was the occurrence of thrombosis in CVCs. The secondary outcomes were possible risk factors for thrombosis, the thrombotic incidence in FVCs, UVCs, and PICCs, and clinical aspects of thrombosis in these groups. A total of 552 neonates received a total of 656 catheters, including 407 (62%) UVCs, 185 (28%) PICCs, and 64 (10%) FVCs. Thrombosis was detected in 14 cases, yielding an overall incidence of 2.1% or 3.6 events per 1000 catheter days. FVC was significantly associated with the occurrence of thrombosis when compared with UVC (P=0.02; odds ratio, 3.8; 95% confidence interval, 1.2-12.0) and PICC (P=0.01; odds ratio, 8.2; 95% confidence interval, 1.6-41.7). The incidence of thrombosis was higher in FVCs than in UVCs and PICCS, that is, 7.8% (5/64), 1.7% (7/407), and 1.1% (2/185), respectively (P<0.01). The number of thrombotic events per 1000 catheter days was 12.3 in FVCs, 3.2 in UVCs, and 1.5 in PICCs (P<0.05). We concluded that thrombosis occurs more frequently in FVCs than in other CVCs.
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40
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Sol JJ, van de Loo M, Boerma M, Bergman KA, Donker AE, van der Hoeven MAHBM, Hulzebos CV, Knol R, Djien Liem K, van Lingen RA, Lopriore E, Suijker MH, Vijlbrief DC, Visser R, Veening MA, van Weissenbruch MM, van Ommen CH. NEOnatal Central-venous Line Observational study on Thrombosis (NEOCLOT): evaluation of a national guideline on management of neonatal catheter-related thrombosis. BMC Pediatr 2018; 18:84. [PMID: 29475450 PMCID: PMC5824541 DOI: 10.1186/s12887-018-1000-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In critically ill (preterm) neonates, central venous catheters (CVCs) are increasingly used for administration of medication or parenteral nutrition. A serious complication, however, is the development of catheter-related thrombosis (CVC-thrombosis), which may resolve by itself or cause severe complications. Due to lack of evidence, management of neonatal CVC-thrombosis varies among neonatal intensive care units (NICUs). In the Netherlands an expert-based national management guideline has been developed which is implemented in all 10 NICUs in 2014. METHODS The NEOCLOT study is a multicentre prospective observational cohort study, including 150 preterm and term infants (0-6 months) admitted to one of the 10 NICUs, developing CVC-thrombosis. Patient characteristics, thrombosis characteristics, risk factors, treatment strategies and outcome measures will be collected in a web-based database. Management of CVC-thrombosis will be performed as recommended in the protocol. Violations of the protocol will be noted. Primary outcome measures are a composite efficacy outcome consisting of death due to CVC-thrombosis and recurrent thrombosis, and a safety outcome consisting of the incidence of major bleedings during therapy. Secondary outcomes include individual components of primary efficacy outcome, clinically relevant non-major and minor bleedings and the frequency of risk factors, protocol variations, residual thrombosis and post thrombotic syndrome. DISCUSSION The NEOCLOT study will evaluate the efficacy and safety of the new, national, neonatal CVC-thrombosis guideline. Furthermore, risk factors as well as long-term consequences of CVC-thrombosis will be analysed. TRIAL REGISTRATION Trial registration: Nederlands Trial Register NTR4336 . Registered 24 December 2013.
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Affiliation(s)
- Jeanine J Sol
- Department of Pediatrics, Groene Hart Hospital, Gouda, the Netherlands.,Neonatal Intensive Care Unit, Sophia Children's Hospital Erasmus MC, Rotterdam, the Netherlands
| | - Moniek van de Loo
- Neonatal Intensive Care Unit, Emma Children's Hospital AMC, Amsterdam, the Netherlands
| | - Marit Boerma
- Department of Pediatric Hematology, Sophia Children's Hospital Erasmus MC, Postbus 2060, 3015 CN, Rotterdam, the Netherlands
| | - Klasien A Bergman
- Neonatal Intensive Care Unit, Beatrix Children's Hospital UMCG, Groningen, the Netherlands
| | - Albertine E Donker
- Department of Pediatric Hematology, Maxima Medisch Centrum, Veldhoven, the Netherlands
| | | | - Christiaan V Hulzebos
- Neonatal Intensive Care Unit, Neonatal Intensive Care Unit, Beatrix Children's Hospital UMCG, Groningen, the Netherlands
| | - Ronny Knol
- Neonatal Intensive Care Unit, Sophia Children's Hospital Erasmus MC, Rotterdam, the Netherlands
| | - K Djien Liem
- Neonatal Intensive Care Unit, Amalia Children's Hospital Radboud UMC, Nijmegen, the Netherlands
| | | | - Enrico Lopriore
- Neonatal Intensive Care Unit, Willem-Alexander Hospital LUMC, Leiden, the Netherlands
| | - Monique H Suijker
- Department of Pediatric Hematology, Emma Children's Hospital AMC, Amsterdam, the Netherlands
| | - Daniel C Vijlbrief
- Neonatal Intensive Care Unit, Wilhelmina Children's Hospital UMCU, Utrecht, the Netherlands
| | - Remco Visser
- Neonatal Intensive Care Unit, Willem-Alexander Hospital LUMC, Leiden, the Netherlands
| | | | | | - C Heleen van Ommen
- Department of Pediatric Hematology, Sophia Children's Hospital Erasmus MC, Postbus 2060, 3015 CN, Rotterdam, the Netherlands.
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Nonconventional mesocaval prosthetic shunt interposition in refractory case with portal hypertension in a 10-kg female infant. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000513182.49296.8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shamir SB, Kurian J, Kogan-Liberman D, Taragin BH. Hepatic Imaging in Neonates and Young Infants: State of the Art. Radiology 2017; 285:763-777. [DOI: 10.1148/radiol.2017170305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Stephanie B. Shamir
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Jessica Kurian
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Debora Kogan-Liberman
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Benjamin H. Taragin
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
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Eifinger F, Fuchs Z, Koerber F, Persigehl T, Scaal M. Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns. Clin Anat 2017; 31:269-274. [PMID: 29044713 DOI: 10.1002/ca.22998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/28/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022]
Abstract
Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. Eighteen stillborns were investigated (29.2 weeks ± 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV. We measured the diameter at the narrowest points of (i) the umbilical vein, (ii) the segmental portal vein, (iii) the left portal vein, (iv) the umbilical recess, and (v) the ductus venosus. The branching angles between (a) the umbilical vein and intrahepatic veins and (b) the ductus venosus and umbilical recess were measured. The diameter of the UV increases from 3.4 to 11 mm (median [IQR]:4.6 mm [4.2-6.9]: r2 = 0.64). The left portal vein has a larger diameter (3.6 mm [2.6-4.55]; r2 = 0.43) than the left segmental portal vein (2.3 mm [1.8-2.75]; r2 = 0.23). The diameter of the ductus venosus (2.5 mm [1.6-3.4]; r2 = 0.59) is half that of the umbilical recess (5.1 mm [3.3-6.2]; r2 = 0.43). The most obtuse angle is formed by the junction between the umbilical recess and ductus venosus (151° [133-159]; r2 = 0.001). The branch angle from the outgoing UV into the left portal vein is more obtuse (128° [123-144]; r2 = 0.0001) than that of the segmental portal vein (115° [105-119]; r2 = 0.0001). To avoid mal-positioning, our data suggest the use of a soft catheter. The UV and its extensions are wide enough to admit a 4 Fr. catheter without complete obstruction. Clin. Anat. 31:269-274, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- F Eifinger
- Department of Pediatric Critical Care Medicine and Neonatology, University Children's Hospital, Cologne, 50926, Germany
| | - Z Fuchs
- Department of Pediatric Critical Care Medicine and Neonatology, University Children's Hospital, Cologne, 50926, Germany
| | - F Koerber
- Department of Radiology, University of Cologne, Cologne, 50926, Germany
| | - T Persigehl
- Department of Radiology, University of Cologne, Cologne, 50926, Germany
| | - M Scaal
- Institute of Anatomy II, University of Cologne, Cologne, 50926, Germany
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Gordon A, Greenhalgh M, McGuire W. Early planned removal of umbilical venous catheters to prevent infection in newborn infants. Cochrane Database Syst Rev 2017; 10:CD012142. [PMID: 29017005 PMCID: PMC6485860 DOI: 10.1002/14651858.cd012142.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lengthy duration of use may be a risk factor for umbilical venous catheter-associated bloodstream infection in newborn infants. Early planned removal of umbilical venous catheters (UVCs) is recommended to reduce the incidence of infection and associated morbidity and mortality. OBJECTIVES To compare the effectiveness of early planned removal of UVCs (up to two weeks after insertion) versus an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants.To perform subgroup analyses by gestational age at birth and prespecified planned duration of UVC placement (see "Subgroup analysis and investigation of heterogeneity"). SEARCH METHODS We used the standard Cochrane Neonatal search strategy including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), Ovid MEDLINE, Embase, and the Maternity & Infant Care Database (until May 2017), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared effects of early planned removal of UVCs (up to two weeks after insertion) versus an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently undertook data extraction. We analysed treatment effects and reported risk ratio (RR) and risk difference (RD) for dichotomous data, and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We planned to use a fixed-effect model in meta-analyses and to explore potential causes of heterogeneity in sensitivity analyses. We assessed the quality of evidence for the main comparison at the outcome level using GRADE methods. MAIN RESULTS We found one eligible trial. Participants were 210 newborn infants with birth weight less than 1251 grams. The trial was unblinded but otherwise of good methodological quality. This trial compared removal of an umbilical venous catheter within 10 days after insertion (and replacement with a peripheral cannula or a percutaneously inserted central catheter as required) versus expectant management (UVC in place up to 28 days). More infants in the early planned removal group than in the expectant management group (83 vs 33) required percutaneous insertion of a central catheter (PICC). Trial results showed no difference in the incidence of catheter-related bloodstream infection (RR 0.65, 95% CI 0.35 to 1.22), in hospital mortality (RR 1.12, 95% CI 0.42 to 2.98), in catheter-associated thrombus necessitating removal (RR 0.33, 95% confidence interval 0.01 to 7.94), or in other morbidity. GRADE assessment indicated that the quality of evidence was "low" at outcome level principally as the result of imprecision and risk of surveillance bias due to lack of blinding in the included trial. AUTHORS' CONCLUSIONS Currently available trial data are insufficient to show whether early planned removal of umbilical venous catheters reduces risk of infection, mortality, or other morbidity in newborn infants. A large, simple, and pragmatic randomised controlled trial is needed to resolve this ongoing uncertainty.
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Affiliation(s)
- Adrienne Gordon
- Royal Prince Alfred HospitalNeonatologyMissenden RoadCamperdownSydneyNSWAustralia2050
| | - Mark Greenhalgh
- RPA Women and Babies, Royal Prince Alfred HospitalRPA Newborn CareSydneyNSWAustralia2050
| | - William McGuire
- Centre for Reviews and Dissemination, The University of YorkYorkY010 5DDUK
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Abstract
Portal vein thrombosis (PVT) is thrombosis of the portal -circulation, which may present with varied symptoms. However, increased use of abdominal imaging has noted a large number of incidental PVT. At the same time, PVT may be overlooked in the absence of the characteristic symptoms. More recently, a JAK2 mutation has been recognised as a cause of PVT. Anticoagulation is the mainstay of treatment, but can pose a dilemma because of the associated coagulopathy, the presence of varices and thrombocytopenia.
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46
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Mutlu M, Parıltan BK, Aslan Y, Eyüpoğlu İ, Kader Ş, Aktürk FA. Comparison of methods and formulas used in umbilical venous catheter placement. TURK PEDIATRI ARSIVI 2017; 52:35-42. [PMID: 28439199 PMCID: PMC5396820 DOI: 10.5152/turkpediatriars.2017.4912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/29/2016] [Indexed: 12/29/2022]
Abstract
AIM Central venous access is frequently provided by way of umbilical venous catheter placement in critically ill newborns. This study compared the methods of Dunn, Shukla-Ferrara, and Revised Shukla-Ferrara in determining the appropriate insertion length of umbilical vein catheters. MATERIAL AND METHODS This prospective observational study was carried out in 121 newborns with umbilical venous catheter, group 1 (n=41) used Dunn method, group 2 (n=40) used the Shukla-Ferrara formula, and group 3 used revised Shukla-Ferrara formula (n=40). Catheter tip position was evaluated with an anterior-posterior chest radiograph after insertion of the umbilical venous catheter. The ideal position for the umbilical venous catheter was defined as the catheter tip being visible between the 9th and 10th thoracic vertebrae on an anterior-posterior chest radiograph. The position of the umbilical venous catheter was considered too high if the tip of the catheter was higher than the 9th thoracic vertebra and too low if the tip was below the 10th thoracic vertebra. The following data were collected: appropriate, inappropriate (low, high) placement, and complications of umbilical venous catheterization. RESULTS In the Shukla-Ferrara group, 53% (17/32) of umbilical venous catheters were placed directly in the appropriate position, compared with 40% (12/30) in the revised Shukla-Ferrara group and 38% (11/29) in the Dunn method group. Umbilical venous catheter-related complications developed in two patients, thrombus in one, and catheter-related blood stream infection in the other. CONCLUSIONS This study showed that the Shukla-Ferrara formula is more accurate in predicting the insertion length for umbilical venous catheters, though statistical significance was not found. Further studies with larger samples are needed on this topic.
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Affiliation(s)
- Mehmet Mutlu
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | | | - Yakup Aslan
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - İlker Eyüpoğlu
- Department of Radiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Şebnem Kader
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Filiz Acar Aktürk
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
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Çakır U, Kahvecioğlu D, Alan S, Erdeve Ö, Atasay B, Uçar T, Arsan S, Çakmaklı H, Ertem M, Atalay S. Portal Vein Thrombosis of a Newborn with Corrected Total Anomalous Pulmonary Venous Return. Turk J Haematol 2017; 32:267-70. [PMID: 26376593 PMCID: PMC4563204 DOI: 10.4274/tjh.2013.0428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR) is a rare and frequently isolated defect identified in 1% to 3% of all congenital heart diseases. To the best of our knowledge, portal vein thrombosis (PVT) associated with TAPVR has not been reported in the literature. We report a successfully managed PVT in a newborn with infracardiac-type TAPVR and review the literature. Anticoagulation therapies were used during the neonatal period to prevent thrombus progression. PVT should be kept in mind in TAPVR patients who have open heart repair with total correction. The treatment in each neonate should be individualized with consideration of the risk/benefit ratio.
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Affiliation(s)
- Ufuk Çakır
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey E-mail:
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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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Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F, Fernández-Fructuoso JR. Catheter tip position and risk of mechanical complications in a neonatal unit. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F, Fernández-Fructuoso JR. [Catheter tip position and risk of mechanical complications in a neonatal unit]. An Pediatr (Barc) 2015; 85:77-85. [PMID: 26652241 DOI: 10.1016/j.anpedi.2015.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/08/2015] [Accepted: 10/19/2015] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The use of central catheters (CC) is associated with mechanical complications (MC). OBJECTIVE Our objetive was to determine the relationship between CC positions and associated MC in neonates. MATERIAL A descriptive analytical study was performed over a six year period in the NICU of the University Hospital Santa Lucía de Cartagena. Details were collected on the CC used, indication, reason for withdrawal, position in the imaging, MC, and treatment arising from them, as well as epidemiological data. RESULTS Of the total of 604 CC studied, the majority (347) were via the umbilical vein, followed by epicutaneous (193), and femoral vein (34). There were MC in 14.2% of catheters. Incorrect position of the tip was associated with greater MC (21.1 vs 8.2%; P<.001), including withdrawal due to MC (8.4 vs 3.1%; P<.01), extravasation (4.9 vs 1.9%; P<.05), pleural and pericardial effusions (1.4 vs 0.0%; P<.05), liver haematomas (4.6 vs 0.6%; P<.01), and ascites (2.8 vs 0.0%; P<.01). The midclavicular epicutaneous position of the tip was associated with greater MC (18.5 vs 6.8%; P<.05) than the brachiocephalic (0 vs 6.8%;NS). The low and ductal position of the umbilical vein catheter was also associated with higher rates of MC (24.5 vs 6%; P<.001 and 27 vs 6%; P<.001) due to the position of the tip. The most common complication was accidentally dislodged catheter. CONCLUSIONS The incorrect location of the tip was associated with more MC. The midclavicular epicutaneous had more risk than centrally or brachiocephalic locations. The low and ductal positions of the umbilical vein catheter were associated with higher rates of MC.
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Affiliation(s)
- Jose Maria Lloreda-García
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España.
| | - Ana Lorente-Nicolás
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Francisca Bermejo-Costa
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Jose Ramón Fernández-Fructuoso
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
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