title: Severe liver injury while using umbilical venous catheter: case series and literature review.
abstract: OBJECTIVE
  Proper position of umbilical venous catheter (UVC) is of importance to avoid severe complications. We review clinical presentations of neonates with UVC who developed catheter-associated liver injury.
  
  
  METHODS
  We reviewed institutional intensive care database (2008-2013) and identified neonates with UVCs who developed severe hepatic injury. We recorded admission diagnosis, gestational age, birth weight, number of days the umbilical catheter was in place, its radiological position at insertion and at the time of injury, presenting clinical signs, and outcomes.
  
  
  RESULTS
  Of 1,081 neonates, 9 (0.8% [95% exact binomial confidence interval, 0.4-1.6%]) with UVC developed severe hepatic injury. All had the UVC malpositioned within the liver circulation. All presentations were life threatening, with acute abdominal distension (hepatomegaly) being the most consistent sign. Two neonates died from complications which were unrelated to catheter-associated liver injury.
  
  
  CONCLUSIONS
  In all neonates with liver injury, UVC was malpositioned within the portal circulation. Despite the fact that our report provides only circumstantial evidence for the mechanism of injury, it supports reports which suggest that "low" UVC position increases potential for this type of complication. Acute onset of abdominal distension in a neonate with UVC should prompt ultrasonographic evaluation of position of the catheter tip.
authors.affiliation: Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
authors.forename: Ruza
authors.initials: R
authors.lastname: Grizelj
authors.affiliation: Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
authors.forename: Jurica
authors.initials: J
authors.lastname: Vukovic
authors.affiliation: Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bojanic
authors.affiliation: Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
authors.forename: Damir
authors.initials: D
authors.lastname: Loncarevic
authors.affiliation: Department of Radiology, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
authors.forename: Ranka
authors.initials: R
authors.lastname: Stern-Padovan
authors.affiliation: Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
authors.forename: Boris
authors.initials: B
authors.lastname: Filipovic-Grcic
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D002404:Catheterization / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D006529:Hepatomegaly; D006801:Humans; D006975:Hypertension, Portal; D007231:Infant, Newborn; D008099:Liver / Q000293:injuries*; D012189:Retrospective Studies; D014463:Ultrasonography; D014471:Umbilical Veins / Q000000981:diagnostic imaging; D014472:Umbilicus