Çakır Salih Çağrı, Özkan Hilal, Dorum Bayram Ali, Köksal Nilgün, Kudretoğlu Pınar, Baytan Birol, Sezgin Melike, Güneş Adalet Meral
Division of Neonatology, Department of Pediatrics, Uludağ University Faculty of Medicine, Bursa, Turkey.
Department of Pediatrics, Uludağ University Faculty of Medicine, Bursa, Turkey.
Turk Pediatri Ars. 2020 Sep 23;55(3):257-262. doi: 10.14744/TurkPediatriArs.2020.65289. eCollection 2020.
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.
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.
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.
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.
脐静脉导管在新生儿期经常使用。超声检查中脐静脉导管相关血栓形成的发生率在1.3%至43%之间。本研究旨在确定在新生儿重症监护病房住院并接受脐静脉导管插入术的患者门静脉血栓形成的发生率和风险。
纳入2016年至2018年在三级新生儿重症监护病房住院并接受脐静脉导管置入的早产儿（孕周≤32周）。从电子患者档案中回顾性获取人口统计学数据、血栓形成的临床危险因素、导管留置天数、导管位置、使用多普勒超声检测血栓形成的时间、治疗方法和持续时间、血栓形成随访及检查情况。
96例可获取完整数据的患者纳入研究。患者的平均孕周为29±2周，平均出生体重为1353±369克。13.5%（n = 13）的患者检测到门静脉血栓形成。其中5例门静脉血栓形成完全闭塞，8例为部分闭塞。所有完全闭塞患者及6例部分闭塞患者均接受低分子肝素治疗，平均疗程为31±13.8天。所有患者血栓形成在7至120天内消失。6例血栓形成患者检测到血栓形成倾向突变，其中4例具有PAI - 1 4G / 5G突变。
门静脉血栓形成在儿童门静脉高压病因中占重要地位，在新生儿期大多无症状，临床难以识别。对脐静脉导管患者在拔除导管后使用多普勒超声进行筛查和随访，对于预防门静脉血栓形成的长期并发症很重要。
