Association between portal vein thrombosis after umbilical vein catheterization and neonatal asphyxia

Abstract

Abstract Background Neonatal portal vein thrombosis (PVT) is frequently related to umbilical venous catheterisation (UVC) but risk factors remain unclear. Objective To analyse the variables associated to PVT in near to full term newborns with UVC, with a focus on newborns exposed to controlled therapeutic hypothermia (CTH) for hypoxic ischemic encephalopathy (HIE). Methods Retrospective cohort study of infants delivered at or after 36 weeks and with a birthweight over 1500g. All infants were assessed for UVC location and PVT using ultrasonography performed between day 5 and day 10 after catheterisation. Results Among 213 eligible patients, PVT was diagnosed in 57 (27%), among them 54 (95%) were localized in the left portal vein branch and 28 (49%) were of grade 1. With all significant factors in univariate analysis considered, higher gestational age at birth (adjusted OR 1.35; 95%CI: 1.12–1.64, P = .002) and duration of UVC placement (adjusted OR 1.36; 95%CI: 1.11–1.67, P = .004) were the main risk factors of PVT. Among 87 infants who were cooled for HIE, 31 (36%) had PVT compared to 26 (21%) in infants without CTH. Using a multivariate model including variables linked to treatment procedures only, an increased PVT incidence was statistically associated with UVC duration (adjusted OR 1.33; 95%CI: 1.08; 1.63, P = .01) and CTH (adjusted OR 1.94; 95%CI: 1.04–3.65, P = .04). Conclusion Left PVT was frequently observed in near to full term neonates with UVC. Among factors linked to treatment procedures, both duration of UVC and CTH exposure for HIE were found to be independent risk factors of PVT.