Öz
Background: Invasive procedures are increasingly used in neonatal intensive care
units. Umbilical catheters are frequently attached to preterm babies. The aim
of this study is to determine the relationship and risk factors of umbilical
catheters inserted in our clinic with portal vein thrombosis (PVT).
Materials and Methods: We retrospectively evaluated preterm infants
with a gestational age of 32 weeks and below, who had a umbilical vein catheter
(UVC) inserted in our neonatal intensive care unit between 01 October 2017 and
31 December 2018, and who had a catheter inserted for at least 6 hours. UVC
inserted cases were evaluated for portal venous doppler ultrasonograpy (USG)
examination before discharge. Perinatal risk factors and properties related to
catheter were evaluated.
Results:
A total of 142 patients underwent UVC insertion. Doppler USG results of 118
patients were achieved. In 15 (9.9%) cases, portal vein thrombosis was detected
by doppler USG. None of the patients with PVT had clinical findings. The mean
gestational age and birth weight were lower in patients with PVT. Thrombosis
was detected in the left branch of portal vein in 14 patients and thrombosis in
the main portal vein in one patient. In a patient with PVT, gestational
diabetes was present in the mother. Patients with PVT had higher rates of late
neonatal sepsis and bronchopulmonary dysplasia, and the length of
hospitalization was longer. In this group, the low placement rate of the
catheter was higher, and the length of catheter stay was longer than other
group.
Conclusions: Umbilical vein catheterization is an important risk factor for the
development of PVT. Especially low birth weight infants with UVC should be
evaluated with portal doppler USG for PVT.
Kaynakça
- 1. Veldman A, Nold MF, Behnke IM. Thrombosis in the critically ill neonate: incidence, diagnosis and management. Vasc Health Risk Manag. 2008;4(6):1337–48.2. Wigger H J, Branselver BR, Blanc WA. Thromboses due to catheterization in infants and children. J Pediatr 1970;76:1-11.3. Morag I, Epelman M, Daneman A, Moineddin R, Parvez B, Shechter T, et al. Portal vein thrombosis in neonates: risk factors, course and outcome. J Pediatr. 2002;148(6):735–9.4. Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odievre M, Alagille D. Portal obstruction in children, I: clinical investigation and hemorrhage risk. J Pediatr 1983;103:696-702.5. Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology 2001;219:645-50.6. Yadav S, Dutta AK, Sarin SK. Do umbilical vein catheterization and sepsis lead to portal vein thrombosis? A prospective, clinical, and sonographic evaluation. J Pediatr Gastroenterol Nutr 1993;17:392-6.7. Scott JM. Iatrogenic lesions in babies following umbilical vein catheterization. Arch Dis Child 1965;40:426-9.8. Seibert JJ, Taylor BJ, Williamson SL, Williams BJ, Szabo JS, Corbitt SL. Sonographic detection of neonatal umbilical artery thrombosis: clinical correlation. AJR Am J Roentgenol 1987;148:965-8.9. Butler-O’ Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D’Angio CT. A randomized trial comparing long term and short-term use of umbilical venous catheter in prematüre infants with birth weight of less than 1251 grams. Pediatrics. 2006;118(1):e25–35.10. Narang I. Review series: what goes around, comes around: childhood influences on later lung health? Long-term follow-up of infants with lung disease of prematurity. Chron Respir Dis 2010;7 (4):259–69.11. Garner A. An international classification of retinopathy of prematurity. Pediatrics 1984;74 (1):127–33.12. O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter–related infections. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention, U.S. Pediatrics.2002;110(5):e51.13. Fraser-Hill MA, Atri M, Bret PM, Aldis AE, Illescas FF, Herschorn SD. Intrahepatic portal venous system: variations demonstrated with duplex and color Doppler US. Radiology 1990;177:523-6.14. Hann LE, Getrajdman GI, Brown KT, Bach AM, Teitcher JB, Fong Y, et al. Hepatic lobar atrophy: association with ipsilateral portal vein obstruction. AJR Am J Roentgenol 1996;167:1017-21.15. Larroche JC. Umbilical catheterization: its complications. Anatomical study. Biol Neonate 1970;16:101e16.16. Schwartz DS, Gettner PA, Konstantino MM, et al. Umbilical venous catheterization and the risk of portal vein thrombosis. J Pediatr 1997;131:760e2.17. Morag I, Epelman M, Daneman A, et al. Portal vein thrombosis in the neonate: risk factors, course, and outcome. J Pediatr 2006;148:735e9.18. Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology 2001;219:645e50.19. Greenway A, Massıcotte Monagle P, Monagle P. Neonatal thrombosis and its treatment. Blood reviews, 2004, 18.2: 75-84.
Öz
Amaç: Yenidoğan yoğun bakım ünitelerinde giderek artan sıklıkta invaziv
girişimler yapılmaktadır. Özellikle preterm bebeklere sıklıkla umblikal kateterler
takılmaktadır. Bu çalışmanın amacı kliniğimizde takılan umblikalkateterlerin
portal ventrombozu (PVT) ile ilişkisini ve risk faktörlerini
belirleyebilmektir.
Materyal ve
metod: Retrospektif olarak 01
Ekim 2017-31 Aralık 2018 tarihleri arasında kliniğimiz yenidoğan yoğun bakım
ünitesinde izlenen gestasyon yaşı 32 hafta ve altında olan, umblikal kateter
takılan ve en az 6 saat boyunca kateter takılı olan preterm bebekler çalışmaya
dahil edildi. Umblikal ven kateteri (UVK) takılan hastaların taburculuk öncesi
PVT açısından yapılan portal venöz doppler ultrasonografi (USG) sonuçları ile
perinatal risk faktörleri ve kateter ile ilgili özellikler değerlendirildi.
Bulgular: 142 hastaya UVK takıldı. 118 hastanın doppler USG sonucuna ulaşıldı. On
beş (%9,9) hastada doppler USG ile PVT saptandı. PVT saptanan hastaların
hiçbirinde klinik bulgu yoktu. PVT saptanan hastaların ortalama gestasyon yaşı
ve doğum ağırlığı, PVT saptanmayan hastalardan daha düşüktü. On dört hastada
portal venin sol dalında tromboz saptanırken, bir hastada ana portal vende tromboz
saptandı.Tromboz saptanan bir hastada annede gestasyonel diyabet mevcuttu. PVT
saptanan hastaların geç neonatal sepsis ve bronkopulmoner displazi oranları
daha yüksekti, hastanede yatış süresi daha uzundu. Yine bu grupta kateterin
alçak yerleşim oranı daha fazla, kateter kalış süresi ise diğer gruba göre daha
uzundu.
Sonuç: Umblikal ven kateterizasyonu PVT gelişimi için önemli bir risk
faktörüdür. UVK takılan, özellikle düşük doğum ağırlıklı hastalar PVT açısından
portal doppler USG ile değerlendirilmelidir.
Anahtar Kelimeler
Kaynakça
- 1. Veldman A, Nold MF, Behnke IM. Thrombosis in the critically ill neonate: incidence, diagnosis and management. Vasc Health Risk Manag. 2008;4(6):1337–48.2. Wigger H J, Branselver BR, Blanc WA. Thromboses due to catheterization in infants and children. J Pediatr 1970;76:1-11.3. Morag I, Epelman M, Daneman A, Moineddin R, Parvez B, Shechter T, et al. Portal vein thrombosis in neonates: risk factors, course and outcome. J Pediatr. 2002;148(6):735–9.4. Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odievre M, Alagille D. Portal obstruction in children, I: clinical investigation and hemorrhage risk. J Pediatr 1983;103:696-702.5. Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology 2001;219:645-50.6. Yadav S, Dutta AK, Sarin SK. Do umbilical vein catheterization and sepsis lead to portal vein thrombosis? A prospective, clinical, and sonographic evaluation. J Pediatr Gastroenterol Nutr 1993;17:392-6.7. Scott JM. Iatrogenic lesions in babies following umbilical vein catheterization. Arch Dis Child 1965;40:426-9.8. Seibert JJ, Taylor BJ, Williamson SL, Williams BJ, Szabo JS, Corbitt SL. Sonographic detection of neonatal umbilical artery thrombosis: clinical correlation. AJR Am J Roentgenol 1987;148:965-8.9. Butler-O’ Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D’Angio CT. A randomized trial comparing long term and short-term use of umbilical venous catheter in prematüre infants with birth weight of less than 1251 grams. Pediatrics. 2006;118(1):e25–35.10. Narang I. Review series: what goes around, comes around: childhood influences on later lung health? Long-term follow-up of infants with lung disease of prematurity. Chron Respir Dis 2010;7 (4):259–69.11. Garner A. An international classification of retinopathy of prematurity. Pediatrics 1984;74 (1):127–33.12. O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter–related infections. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention, U.S. Pediatrics.2002;110(5):e51.13. Fraser-Hill MA, Atri M, Bret PM, Aldis AE, Illescas FF, Herschorn SD. Intrahepatic portal venous system: variations demonstrated with duplex and color Doppler US. Radiology 1990;177:523-6.14. Hann LE, Getrajdman GI, Brown KT, Bach AM, Teitcher JB, Fong Y, et al. Hepatic lobar atrophy: association with ipsilateral portal vein obstruction. AJR Am J Roentgenol 1996;167:1017-21.15. Larroche JC. Umbilical catheterization: its complications. Anatomical study. Biol Neonate 1970;16:101e16.16. Schwartz DS, Gettner PA, Konstantino MM, et al. Umbilical venous catheterization and the risk of portal vein thrombosis. J Pediatr 1997;131:760e2.17. Morag I, Epelman M, Daneman A, et al. Portal vein thrombosis in the neonate: risk factors, course, and outcome. J Pediatr 2006;148:735e9.18. Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology 2001;219:645e50.19. Greenway A, Massıcotte Monagle P, Monagle P. Neonatal thrombosis and its treatment. Blood reviews, 2004, 18.2: 75-84.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 25 Aralık 2019 |
| Gönderilme Tarihi | 5 Mayıs 2019 |
| Kabul Tarihi | 30 Ekim 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 16 Sayı: 3 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty