Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2021; 13(11): 1802-1815
Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1802
Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis
Iliana Bersani, Fiammetta Piersigilli, Giulia Iacona, Immacolata Savarese, Francesca Campi, Andrea Dotta, Cinzia Auriti, Enrico Di Stasio, Matteo Garcovich
Iliana Bersani, Immacolata Savarese, Francesca Campi, Andrea Dotta, Cinzia Auriti, Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
Fiammetta Piersigilli, Department of Neonatology, Cliniques Universitaires Saint Luc, Universitè Catholique de Louvain, Bruxelles 1200, Belgium
Giulia Iacona, Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
Enrico Di Stasio, Department of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma 00168, Italy
Matteo Garcovich, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Matteo Garcovich, CEMAD Digestive Disease Center, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Author contributions: Bersani I, Piersigilli F, Iacona G, Di Stasio E and Garcovich M contributed to conceptualization, systematic review, investigation, supervision, writing first draft, review and editing; Savarese I, Campi F, Dotta A and Auriti C contributed to conceptualization, investigation, review and editing; all authors revised the manuscript critically for intellectual content and have approved the final version.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Enrico Di Stasio, MD, PhD, Academic Research, Doctor, Department of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo gemelli 8, Roma 00168, Italy.
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: August 18, 2021
Revised: August 31, 2021
Accepted: October 14, 2021
Article in press: October 14, 2021
Published online: November 27, 2021

The use of umbilical venous catheters (UVCs) in the perinatal period may be associated with severe complications, including the occurrence of portal vein thrombosis (PVT).


To assess the incidence of UVC-related PVT in infants with postnatal age up to three months.


A systematic and comprehensive database searching (PubMed, Cochrane Library, Scopus, Web of Science) was performed for studies from 1980 to 2020 (the search was last updated on November 28, 2020). We included in the final analyses all peer-reviewed prospective cohort studies, retrospective cohort studies and case-control studies. The reference lists of included articles were hand-searched to identify additional studies of interest. Studies were considered eligible when they included infants with postnatal age up to three months with UVC-associated PVT. Incidence estimates were pooled by using random effects meta-analyses. The quality of included studies was assessed using the Newcastle-Ottawa scale. The systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.


Overall, 16 studies were considered eligible and included in the final analyses. The data confirmed the relevant risk of UVC-related thrombosis. The mean pooled incidence of such condition was 12%, although it varied across studies (0%-49%). In 15/16 studies (94%), diagnosis of thrombosis was made accidentally during routine screening controls, whilst in 1/16 study (6%) targeted imaging assessments were carried out in neonates with clinical concerns for a thrombus. Tip position was investigated by abdominal ultrasound (US) alone in 1/16 (6%) studies, by a combination of radiography and abdominal US in 14/16 (88%) studies and by a combination of radiography, abdominal US and echocardiography in 1/16 (6%) studies.


To the best of our knowledge, this is the first systematic review specifically investigating the incidence of UVC-related PVT. The use of UVCs requires a high index of suspicion, because its use is significantly associated with PVT. Well-designed prospective studies are required to assess the optimal approach to prevent UVC-related thrombosis of the portal system.

Keywords: Portal vein thrombosis, Umbilical venous catheter, Portal system thrombosis, Hepatic thrombosis, Neonate, Incidence

Core Tip: Portal vein thrombosis (PVT) is a dreadful complication that can occur after umbilical vein catheterization in neonates. Although previous observational studies have provided a general overview about the risk of this complication, the present systematic review specifically investigates the incidence catheter-related PVT and identifies relevant gaps in knowledge about the optimal diagnostic approach highlighting the need for prospective randomized studies and updated guidelines.