Adalet Meral GÜNEŞ, Melike SEZGİN, Birol BAYTAN, Bayram Ali DORUM, Hilal ÖZKAN, Salih Çağrı ÇAKIR, Nilgün KÖKSAL, Pınar KUDRETOĞLU

Prematüreleri bekleyen tehlike: Portal ven trombozları

Amaç: Yenidoğan döneminde sıklıkla kullanılmakta olan göbek ven kateterlerine bağlı olarak, ultrasonografi taramalarında %1,3-43 arasında değişen oranlarda tromboz sıklığı bildirilmektedir. Bu çalışmada, yenidoğan yoğun bakım biriminde yatıp göbek ven kateteri takılan hastalarda, portal ven trombozu gelişme oranları ve risklerinin belirlenmesi amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya 2016–2018 yılları arasında üçüncü basamak yoğun bakım biriminde yatan ve göbek ven kateteri yerleştirilen 32 gebelik hafta ve altındaki erken doğan bebekler alındı. Hastaların demografik verileri, tromboz açısından klinik risk etmenleri, kateter kalış gün sayıları, kateter yerleşim yerleri, Doppler ultrasonografi ile tromboz saptanma zamanları, tedavi yöntem ve süreleri, tromboz izlem ve tetkikleri geriye dönük olarak hastane bilgi sistemindeki elektronik hasta dosyalarından elde edildi.Bulgular: Çalışmaya tüm verilerine ulaşılabilen 96 hasta alındı. Hastaların ortalama gebelik yaşları 29±2 hafta ve ortalama doğum ağırlıkları 1 353±369 gramdı. Hastaların %13,5’inde (n=13) portal ven trombozu saptandı. Portal ven trombozlarının beşi tam, sekizi kısmi tıkanma şeklindeydi. Tam tıkanma saptanan hastaların hepsine ve kısmi tromboz saptanan altı hastaya ortalama 31±13,8 gün düşük molekül ağırlıklı heparin tedavisi uygulandı, hastaların tümünde tromboz 7–120 gün arasında kayboldu. Tromboz saptanan altı hastada trombofili mutasyonu saptandı, dördü PAI-1 4G/5G mutasyonu şeklindeydi.Çıkarımlar: Çocukluk döneminde portal hipertansiyon nedenlerinden olan portal ven trombozları yenidoğan döneminde çoğunlukla semptomsuz olup klinik olarak tanınamamaktadırlar. Göbek ven kateteri yerleştirilen hastaların kateter çekildikten sonra portal ven trombozu açısından Doppler ultrasonografiyle taranması ve izlemi, uzun dönem komplikasyonların önlenmesi için önemlidir.

The danger awaiting premature babies: Portal vein thrombosis

Aim: Umbilical venous catheters are frequently used in the neonatal period. The incidence of umbilical venous catheter-related thrombosis is between 1.3% and 43% in ultrasound scans. This study aimed to determine the incidence and risk of portal vein thrombosis in patients who were hospitalized in the neonatal intensive care unit and underwent umbilical venous catheter insertion.Material and Methods: Premature infants (≤32 gestational weeks) whowere hospitalized in a Level III neonatal intensive care unit and underwent umbilical vein catheter placement between 2016 and 2018, were included in the study. The demographic data, clinical risk factors for thrombosis, number of catheter days, catheter locations, times of detection of thrombosis using Doppler ultrasonography, treatment methods and durations, thrombosis follow-up and examinations were obtained retrospectively from the electronic patient files.Results: Ninety-six patients whose complete data could be reached wereenrolled in the study. The mean gestational age of the patients was found as 29±2 weeks and the mean birth weight was 1353±369 g. Portal vein thrombosis was detected in 13.5% (n=13) of the patients. Five of thecases of portal vein thrombose were complete occlusion and eight werepartial occlusion. All patients with complete occlusion and six patientswith partial occlusion were treated with low-molecular-weight heparin for a mean duration of 31±13.8 days. Thrombosis disappeared in 7–120days in all patients. A thrombophilia mutation was detected in six patients with thrombosis, four of whom had the PAI-1 4G / 5G mutation.Conclusion: Portal vein thrombosis which has a significant place amongthe causes of portal hypertension in childhood, is mostly asymptomaticin the neonatal period and cannot be recognized clinically. It is important to screen and follow up patients with umbilical vein catheters using Doppler ultrasonography in terms of PVT after catheter removal to prevent long-term complications.

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