Portal vein thrombosis in the neonate: Risk factors, course, and outcome

Objective

To determine the risk factors, clinical features, and outcome of infants diagnosed with portal vein thrombosis (PVT).

Study design

A retrospective chart review was conducted of all consecutive infants admitted to the Hospital for Sick Children, Toronto, between January 1999 and December 2003 diagnosed with PVT.

Results

PVT was diagnosed in 133 infants, all but 5 of whom were neonates, with a median age at time of diagnosis of 7 days. An umbilical venous catheter (UVC) was inserted in 73% of the infants and was in an appropriate position in 46% of them. Poor outcome, defined as portal hypertension or lobar atrophy, was diagnosed in 27% of the infants and was significantly more common in those with an initial diagnosis of grade 3 PVT and in those with a low or intrahepatically placed UVC. Anticoagulation treatment did not appear to have a significant effect on outcome.

Conclusions

PVT occurs early in life; major risk factors in addition to the neonatal period are placement of UVC and severe neonatal sickness. Poor outcome is associated with an improperly placed UVC and with grade 3 thrombus.

Abbreviations:  CHD, Congenital heart defect , NICU, Neonatal intensive care unit , PHTN, Portal hypertension , PVT, Portal vein thrombosis , TE, Thromboembolic event , USG, Ultrasonography , UVC, Umbilibal venous catheter , VTE, Venous thromboembolic events