Fibrinolytic treatment of portal vein thrombosis after umbilical catheterization using systemic urokinase

Neonatal tendency to develop thrombotic lesions is a well-known phenomenon. Low birthweight infants appear to be particularly susceptible to thrombosi s induced by vascular catheters. The small size of the vessels in these pat ients and their often more compromised cardiac output account for the highe r risk of catheter-associated thrombosis.(1) Additional causes are the thro mbogenic properties of some catheters causing the deposition of platelets a nd/or fibrinogen and their traumatic effect on the vessel wall endothelium. It is generally believed that umbilical vein catheters located in a slow-f low system are associated with a greater risk of thrombosis than are arteri al catheters. Portal vein thrombosis (PVT), resulting in portal hypertensio n, has been described as the most common complication of umbilical vein cat heterization. For patients at risk, frequent evaluation of PVT using ultras onography(2) shortly after initiation of umbilical vein catheterization can be the most important approach in terms of 'early detection'. The purpose of the present article is to review thrombosis in the neonatal period with emphasis on diagnosis and treatment.