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Scenario
While working on a neonatal unit, you look after a baby born at 28 weeks gestational age, who required umbilical venous catheter (UVC) insertion following birth. During a routine echocardiogram examination to assess the patent ductus arteriosus, an incidental finding of an echogenic, non-occlusive thrombus was identified in the left portal vein. This was thought to be secondary to the UVC placement.
You wonder how many preterm babies who have UVCs inserted in the neonatal unit develop portal venous thrombosis and who have complications from this.
Structured clinical question
What is the prevalence of portal vein thrombosis following UVC insertion in preterm neonates born ≤32 weeks or very low birthweight infants (<1500 grams)? What is the prevalence of long-term significant complications of this?
Search
We searched MEDLINE, Embase and CINAHL databases using the Ovid interface, limiting to articles published after 1990, using the following search strategy: (“Neonate” OR “newborn” or “neonatal” OR “neonatal intensive care unit” OR “newborn intensive care unit” OR “NICU” OR “premature” OR “prematurity” OR “preterm” OR “extremely premature” OR “low birth weight” OR “extremely low birth weight” OR “very low birth weight” OR “LBW” OR “VLBW”) AND (“Umbilical venous catheter” OR “umbilical venous line” OR umbilical venous access” OR “UVC”) AND (“Thrombus” OR “liver vein thrombus” OR “portal vein thrombus” OR “thrombi” OR “blood clot” OR “blood clotting” OR “portal hypertension” OR “conjugated bilirubinaemia” OR “conjugated hyperbilirubinaemia” OR “neonatal hepatitis” OR “hepatic abscess” OR “death” OR “mortality” OR “liver injury” OR “hepatic injury”). We performed the search in January 2023.
A total of 224 articles were found from the search. Nine systematic review articles were found, and an additional four references from these were screened. We excluded case studies or case series. Conference abstracts were included if they included sufficient information to answer the research question. Studies were included if …
Footnotes
Contributors NR initiated the project, formed the clinical question and completed the literature search. Both NR and TJvH independently reviewed the titles, abstracts and full-text articles. NR wrote the manuscript. TJvH proof-read a few drafts and with further input strengthened the quality of the article. PRAM connects paediatric trainees with research interests across the West Midlands Region to allow for collaboration in projects, including evidence reviews.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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