Bersani Iliana, Piersigilli Fiammetta, Iacona Giulia, Savarese Immacolata, Campi Francesca, Dotta Andrea, Auriti Cinzia, Di Stasio Enrico, Garcovich Matteo
Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy.
Department of Neonatology, Cliniques Universitaires Saint Luc, Universitè Catholique de Louvain, Bruxelles 1200, Belgium.
World J Hepatol. 2021 Nov 27;13(11):1802-1815. doi: 10.4254/wjh.v13.i11.1802.
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).
To assess the incidence of UVC-related PVT in infants with postnatal age up to three months.
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.
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.
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.
围产期使用脐静脉导管（UVC）可能会引发严重并发症，包括门静脉血栓形成（PVT）。
评估出生后三个月内婴儿中与UVC相关的PVT的发生率。
对1980年至2020年的研究进行了系统全面的数据库检索（PubMed、Cochrane图书馆、Scopus、科学网）（检索于2020年11月28日最后更新）。我们将所有经过同行评审的前瞻性队列研究、回顾性队列研究和病例对照研究纳入最终分析。对纳入文章的参考文献列表进行人工检索，以识别其他感兴趣的研究。当研究纳入出生后三个月内患有与UVC相关的PVT的婴儿时，该研究被视为符合条件。使用随机效应荟萃分析汇总发病率估计值。使用纽卡斯尔-渥太华量表评估纳入研究的质量。系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。
总体而言，16项研究被认为符合条件并纳入最终分析。数据证实了与UVC相关的血栓形成的相关风险。这种情况的平均合并发病率为12%，尽管不同研究有所差异（0%-49%）。在16项研究中的15项（94%）中，血栓形成的诊断是在常规筛查控制期间偶然做出的，而在16项研究中的1项（6%）中，对有血栓临床疑虑的新生儿进行了针对性的影像学评估。在16项研究中的1项（6%）中，仅通过腹部超声（US）调查尖端位置，在16项研究中的14项（88%）中通过X线摄影和腹部超声联合调查，在16项研究中的1项（6%）中通过X线摄影、腹部超声和超声心动图联合调查。
据我们所知，这是第一项专门调查与UVC相关的PVT发生率的系统评价。UVC的使用需要高度怀疑，因为其使用与PVT显著相关。需要设计良好的前瞻性研究来评估预防门静脉系统与UVC相关血栓形成的最佳方法。
