Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates

Abstract

Purpose: To establish, by means of serial ultrasonography (US), the incidence and natural history of neonatal portal venous thrombosis associated with catheterization of the umbilical vein and to evaluate the potential risk factors predisposing patients to thrombus formation.

Materials and methods: Neonates who had undergone umbilical vein catheterization were studied. US was performed at 2-7-day intervals, before and after the removal of the catheter, until clot resolution or hospital discharge. The presence of portal venous thrombosis and temporal evolution were noted, and various risk factors were analyzed.

Results: US demonstrated clinically silent portal venous thrombosis in 43 (43%) of 100 neonates. Follow-up US revealed complete or partial resolution in 20 (56%) of 36 babies. A significant (P =.024) correlation was found between the initial size of the thrombi and spontaneous clot resolution. Statistically significant risk factors were catheterization for more than 6 days (P =.001) and transfusion (P =.019).

Conclusion: Portal venous thrombosis is frequently associated with the placement of an umbilical venous catheter, and spontaneous resolution is expected in many cases. The duration of catheter placement should be minimized, and US monitoring is recommended as a guide to catheter removal.