Liver injury associated with umbilical venous catheter in preterm infants: a clinical research

Abstract

Objective To study the clinical presentations, radiologic features, prognosis, and possible causes of liver injury associated umbilical venous catheter (UVC). Methods We reviewed database of our NICU from December 2012 to November 2015 and identified preterm infants with liver injury while UVC in place. The gestational age, birth weight, gender, days of UVC in place prior to liver injury, the depth of UVC (cm), UVC tip position, ultrasound findings of liver injury, laboratory tests, treatment and outcomes were collected. Results During study period, 322 infants received UVC insertion. Ten cases (3.1%) of liver injury associated with UVC were diagnosed. Of the ten infants, nine were diagnosed as extravasation of fluid to liver parenchyma, and one was diagnosed as liver hematoma. The mean birth weight was (1 184±207) g, mean gestational age was (28.5±1.7) weeks. The UVC tip was at thoracic (T) vertebrae T 9 to T 11 level, nine UVC tips were below the right diaphragm level. All UVCs were used for total parenteral nutrition before liver injury was diagnosed. Six infants had clinical manifestations, and four infants were free of clinical manifestations. The most prominent clinical signs were abdominal distension (n=5), weak bowel sounds (n=5) and hepatomegaly (n=4). One infant who was diagnosed with liver hematoma also had progressive hemoglobin decline (minimum 34 g/L) and shock. Abdominal ultrasound showed well-limited, irregular, hyperechoic rimmed lesions with heterogeneously hypoechoic centers or anechoic liquid dark space. Extravasation of fluid to liver parenchyma will restorate within one week after the UVC was remove. One baby who was diagnosed as liver hematoma passed away at 9 days of life. Liver ultrasound of eight returned to normal in 52 days to 3.5 months, and one had calcified lesions at 9 months of age. Conclusions Liver injury is an unusual complication of UVC insertion and usage. Proper positioning of the UVC tip may help to avoid this complication. Early recognition, prompt diagnosis with liver ultrasound examination and timely treatment can lead to better outcome in newborns with extravasation of fluid to liver parenchyma. Key words: Catheterization, central venous; Catheters, indwelling; Umbilical veins; Liver injury; Ultrasonography