Authors : Azitoune Sanae; Khaoula Kabbaj; Salahiddine Saghir; Rachid Abilkassem

Volume/Issue : Volume 9 - 2024, Issue 10 - October

Google Scholar : https://tinyurl.com/bda5p7jd

Scribd : https://tinyurl.com/bdcurz92

DOI : https://doi.org/10.38124/ijisrt/IJISRT24OCT261

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Abstract : Septic thrombophlebitis of the umbilical vein (SVT) is a serious pathology in neonates, characterized by inflammation of the umbilical vein due to bacterial infection, with 90% of cases linked to the use of central venous catheters (CVCs). This inflammation can lead to thrombus formation as part of the immune system's response. Premature newborn, 33 weeks gestation, delivered vaginally, with history of gestational diabetes, twin pregnancy, macrosomia and premature rupture of membranes (57 hours), initially well adapted to extrauterine life, with a birth weight of 1575 g. The infant was admitted to neonatology for respiratory distress, and an intrahepatic umbilical catheter was inserted. On the 5th day of hospitalization, the infant developed a nosocomial Klebsiella pneumoniae infection, complicated by a fulminant hemorrhagic syndrome with hematemesis and melena. The clinical course was further complicated by multivisceral failure, requiring hepatic Doppler ultrasound, which revealed umbilical vein thrombosis. The newborn was treated with curative doses of Lovenox, while targeted antibiotic therapy was maintained for three weeks after negative blood cultures, resulting in significant clinical and biological improvement. Based on this case, we conclude that it is advisable to think about umbilical vein thrombosis and to perform an abdominal ultrasound in the presence of any digestive hemorrhage in a newborn or an intrahepatic or peripheral umbilical venous catheter, or in subjects at risk (hypotrophy, polycythemia, transfusion on the catheter) in order to screen for possible umbilical or portal vein thrombosis.

Keywords : Newborn, Thrombosis, Infection, Lovenox.

References :

1. Frasca, D., Dahyot-Fizelier, C., & Mimoz, O. Prevention of central venous catheter-related infections in the intensive care unit. Crit Care 2010; 14:212.
2. O'Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., et al. Summary of recommendations: Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52:1087-99.
3. Marik, P. E., Flemmer, M., & Harrison, W. The risk of catheter-related bloodstream infection with femoral venous catheters compared to subclavian and internal jugular venous catheters: A systematic review of the literature and meta-analysis. Crit Care Med 2012; 40:2479-85.
4. Heifetz, S. A. Umbilical cord thrombosis: Analysis of 52 cases and review of the literature. Pediatr Pathol 1988.
5. Primignani, M. Portal vein thrombosis. Digestive and Hepatic Diseases 2010; 42:163-170.
6. L'Hériteau, F., et al. Network surveillance of catheter-based bacteremia in neonatology: 2010 results from the NEOCAT network. Arch Pediatr 2012; 19:984-989.
7. Timsit, J. F. Updating of the 12th consensus conference of the Société de Réanimation de Langue Française (SRLF): Catheter-related infections in the intensive care unit. Ann Fr Anesth Reanim 2005; 24:315-22.
8. Blot, F., Nitenberg, G., Chachaty, E., Raynard, B., Germann, N., Antoun, S., et al. Diagnosis of catheter-related bacteremia: Prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 1999; 354:1071-7.
9. Monagle, P., Chalmers, E., Chan, A., et al. Antithrombotic therapy in neonates and children: Evidence-based clinical practice guidelines from the American College of Chest Physicians (eighth edition). Chest 2008; 133(Suppl. 6):887S-968S.
10. Çakır, U., Kahvecioglu, D., Alan, S., et al. Portal vein thrombosis in a newborn with corrected total abnormal pulmonary venous return. Turk J Hematol 2015; 32:267-70.
11. Rambaud, J., Grévent, D., & Bergounioux, J. Portal vein thrombosis and stroke in a patient with tetralogy of Fallot. J Pediatr Gastroenterol Nutr 2015; 60:4.
12. Morag, I., Epelman, M., Daneman, A., et al. Portal vein thrombosis in the newborn: Risk factors, course, and outcome. J Pediatr 2006; 148:735-9.
13. Solgun et al. Neonatal portal vein thrombosis: Risk factors, diagnosis, therapeutic recommendations, and literature review. J Thromb 2023; 21:62.
14. Jonathan, T. Septic thrombosis of the cavernous sinus. Ophthalmology Survey 2021; 66:1021–1030.
15. Hepponstall, M., Chan, A., & Monagle, P. Anticoagulation therapy in neonates, children, and adolescents. Blood Cells, Molecules and Diseases 2017; 67:41-47.
16. Kim, J. H., Lee, Y. S., Kim, S. H., Lee, S. K., Lim, M. K., & Kim, H. S. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology 2001; 219:645-50.
17. Choudhry, A. J., Baghdadi, Y. M. K., Amr, M. A., Alzghari, M. J., Jenkins, D. H., & Zielinski, M. D. Pylephlebitis: A review of 95 cases. J Gastrointest Surg 2016; 20(3):656-661.
18. Jonathan, T., Caran, F. A., et al. Septic cavernous sinus thrombosis: A review. Ophthalmology Survey 2021; 66:1021–1030.
19. Brun-Buisson, C., Abrouk, F., Legrand, P., Huet, Y., Larabi, S., & Rapin, M. Diagnosis of central venous catheter-related sepsis: Critical level of quantitative tip cultures. Arch Intern Med 1987; 147:873-7.
20. Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355:2725–32.
21. Ilunga, S. Umbilical vein thrombosis: About two observations. Arch Pediatr 2008; 15(5):1005-1006.