Inferior vena cava syndrome in neonates: An evidence‐based systematic review of the literature

Abstract

Neonatal inferior vena cava syndrome (IVCS), though uncommon, is associated with significant morbidity and mortality. Information on risk factors, diagnosis, treatment, and outcomes is limited. This review comprised 61 neonates across 33 reports. Thrombosis occurred in 98% and 42% involved a central venous catheter. Diagnosis was mainly established by ultrasound in 82%. Therapeutically, heparin was employed in 36% and thrombolysis in 18% of the cases. The overall mortality was 23%. An algorithm of clinical signs, investigation, and management is presented. Well‐designed prospective studies are needed to establish a concrete investigational approach to neonatal IVCS and institute safe, evidence‐based treatment.

Vena Cava Thrombosis after Congenital Diaphragmatic Hernia Repair: Multivariate Analysis of Potential Risk Factors

“…The concomitant use of solutions with different osmolarity and pH may further degrade vascular endothelium, activating the clotting cascade, and promoting thrombosis. 11 In our CDH cohort, although all patients who developed vena cava thrombosis had a previous placement of central vein line from saphenous or femoral vein, the association between central venous catheter from inferior venous system and thrombosis of the vena cava inferior was only hardly significant. No correlation was found for central vein lines inserted from the upper venous system and thrombosis of the vena cava superior.…”

“…10 Inferior vena cava thrombosis may result in decreased venous return to the heart, leading to inferior vena cava syndrome, defined as constellation of symptoms deriving from complete obstruction of the vena cava inferior such as tachycardia, peripheral edema, and renal failure. 11 Superior vena cava thrombosis may result in elevated venous pressure and consecutive chylothorax. 12 13…”

“…10 Inferior vena cava thrombosis may result in decreased venous return to the heart, leading to inferior vena cava syndrome, defined as constellation of symptoms deriving from complete obstruction of the vena cava inferior such as tachycardia, peripheral edema, and renal failure. 11 Superior vena cava thrombosis may result in elevated venous pressure and consecutive chylothorax. 12,13 The exact incidence of neonatal thrombosis is difficult to determine because diagnostic procedures are usually performed after thromboembolic complications and large-population studies are lacking.…”

Transcatheter stent implantation in a child with severe stenosis of the inferior caval vein secondary to injury

“…He underwent multiple procedures including placement of an extra ventricular drain and intracranial pressure monitor, reconstructive facial surgery, upper and lower extremity Over the course of his postoperative hospitalisation, he developed extensive lymphatic drainage with chylothorax, chyloperitoneum, and severe abdominal ascites [7][8][9] (Fig 1 Chest X-ray). He was initiated on a chylous effusion protocol including pausing all enteral intake, diuretics, and treatment with octreotide and required placement of bilateral chest tubes and an abdominal drain considering his persistent high volume output.…”

“…11 Noninvasive imaging including abdominal ultrasonography was initially unremarkable however a follow-up chest computed tomography angiogram demonstrated severe stenosis of his inferior caval vein at the right atrial junction (Fig 2). 8,9 The aetiology of the stenosis was thought to be the initial severe abdominal trauma. Considering this finding he was taken to the cardiac catheterisation laboratory.…”