Imaging-guided percutaneous needle aspiration or catheter drainage of neonatal liver abscesses: 14-year experience

Abstract

Objective: The purpose of our study was to review the clinical aspects and long-term outcomes of imaging-guided percutaneous aspiration or drainage of liver abscesses in neonates.

Materials and methods: We retrospectively reviewed the clinical and imaging records of eight neonates with liver abscesses referred for imaging-guided percutaneous aspiration or drainage, including one autopsy-proven case in whom the percutaneous aspiration or drainage was not performed. Clinical and imaging features, complications, and long-term follow-up results were assessed.

Results: Eight neonates with liver abscesses were referred for imaging-guided percutaneous aspiration or drainage (five males, three females; age range, 7-100 days; weight, 610-3,400 g). Six were born prematurely (24-29 weeks of gestation). Six had a history of umbilical catheterization. All were clinically septic. All neonates received long-term i.v. antibiotics. Five neonates had solitary multiloculated abscesses (right lobe [n = 3], straddling both lobes [n = 2]), and three had solitary uniloculated abscesses (right lobe [n = 1] and left lobe [n = 2]). Imaging-guided drainage catheter insertion (n = 4), aspiration (n = 2), and aspiration followed by drainage catheter insertion (n = 1) were performed in seven neonates within 1 day after referral. Coagulase-negative Staphylococcus (4/8) was the most common organism isolated from blood and pus. There were no procedure-related complications. Catheter repositioning was required in one. Serial sonography (mean, 12.5 months) and clinical follow-up (mean, 20.7 months) showed complete clinical remission in seven cases. Three healed with calcification in the previous abscess site. Long-standing left portal vein thrombosis was seen in two cases.

Conclusion: Neonatal liver abscess is associated with good long-term outcome and minimal complications when imaging-guided percutaneous aspiration or drainage is performed in conjunction with long-term antibiotic coverage.