Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience

Chen, Hsin-Jen; Chao, Hsun‐Chin; Chiang, Ming-Chou; Chu, Shih-Ming

doi:10.1016/j.pedneo.2019.05.004

Cited by 19 publications

(27 citation statements)

References 25 publications

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“…The characteristics and most relevant findings of the included studies are summarized in Table 2 [ 5 , 21 , 30 - 32 , 37 - 45 ]. Of the 16 included studies, 14 were prospective and 2 were retrospective[ 15 , 46 ]. In some cases, the information about the clinical features of the included population was generically related to the overall cohort rather than specifically to neonates with UVC-related PVT and could not be extrapolated.…”

Section: Resultsmentioning

confidence: 99%

Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis

Bersani¹,

Piersigilli²,

Iacona³

et al. 2021

WJH

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BACKGROUND 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). AIM To assess the incidence of UVC-related PVT in infants with postnatal age up to three months. METHODS 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. RESULTS 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. CONCLUSION 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.

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Section: Resultsmentioning

confidence: 99%

Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis

Bersani¹,

Piersigilli²,

Iacona³

et al. 2021

WJH

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“…In a large study by Chen et al . the lobulated a wedge shape lesions with hyper echogenicity and heterogeneity were features of UVC-related hepatic lesions [ 32 ]. Hepatic lesions were located in 72.7 % of cases in the left lobe, 21 % in the right lobe and 6 % in both lobes.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus gallolyticus subspecies pasteurianus causing early onset neonatal sepsis complicated by solitary liver abscess in a preterm infant

Geetha

Cherie

Natalie

et al. 2021

Access Microbiology

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Streptococcus gallolyticus ssp pasteurianus (SGp) is an uncommon but increasingly recognized cause of neonatal sepsis and meningitis. Liver abscess in neonates is extremely rare. But liver abscess due to SG has never been reported in the literature. We present the first case of liver abscess due to SGp in a late preterm infant. A female infant was born at 36 weeks via normal vaginal delivery to a mother with unremarkable antenatal history. She had progressively worsening respiratory distress since birth and was intubated at 13 h of life. One dose of surfactant was delivered and ventilation continued. Parenteral crystalline Penicillin and Gentamicin were initiated and her blood culture at birth grew SGp. She had a spike of fever on day 5 of life. An ultrasound (US) scan of the abdomen was included in the septic work up. A multi-septated cystic liver abscess was noted in the right lobe of the liver. As there was inadequate response to appropriate intravenous antibiotics, needle aspiration and biopsy were performed on day 35 of life. Aspirate was sterile and histopathology confirmed a liver abscess. The patient continued to be treated with antibiotics for 8 weeks with serial US scans of the liver showing resolution of the abscess. Increasing awareness among paediatric and neonatal fraternity about these new emerging bacterial infections can facilitate early diagnosis and treatment.

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“…Malposition has been recognised as the most common UVC-related complication and the most important risk factor for hepatic extravasation in literature. 15 Point-of-care ultrasonography is a valuable adjunct investigation to confirm UVC tip placement, especially when information from standard radiographs is uncertain. The clinical spectrum of extravasation injury varies widely from insidious ascites, unexplained change in biochemical parameters to rapid intravascular volume depletion, and potentially catastrophic renal failure.…”

Section: Discussionmentioning

confidence: 99%

Acute Management of Intraperitoneal Extravasation of Total Parenteral Nutrition (TPN) in a Very Preterm Infant: Case Report and Literature Review

Majid¹,

Barrett²,

Meyer³

2021

RRN

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Purpose: Use of umbilical catheters is standard practice in neonatal intensive care units due to ease of insertion and provision of longer-term vascular access. Complications of umbilical venous catheters, including extravasation of total parenteral nutrition (TPN) fluid, are rare but when they occur have high mortality and morbidity. Umbilical venous catheters tend to migrate over time, and their position may change, so a high index of suspicion should be maintained. Our aim was to describe a case with extravasation of parenteral nutrition fluid and review the medical literature. Patients and Methods: Case report. Results: The infant was born at 28 weeks' gestation (1510 g). On day 6 he presented with nonspecific abdominal distension, hypotension, respiratory deterioration, metabolic acidosis and was critically ill. Radiological and ultrasound findings were consistent with TPN ascites due to a malpositioned umbilical venous catheter. Bedside paracentesis without laparotomy was carried out. Despite a stormy course, the infant recovered and the liver injury with conjugated hyperbilirubinemia improved over a period of several months. Conclusion: Emergency bedside ultrasound and paracentesis with catheter removal may be lifesaving and avoid laparotomy in an already critically unwell preterm infant.

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Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience

Cited by 19 publications

References 25 publications

Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis

Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis

Streptococcus gallolyticus subspecies pasteurianus causing early onset neonatal sepsis complicated by solitary liver abscess in a preterm infant

Acute Management of Intraperitoneal Extravasation of Total Parenteral Nutrition (TPN) in a Very Preterm Infant: Case Report and Literature Review

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