Umbilical venous catheter tip position and risk of portal vein thrombosis in neonates: a retrospective cohort study.

PURPOSE: Umbilical vein catheterization (UVC) is widely used for vascular access in sick, especially preterm neonates. However, UVC placement is associated with an increased risk of portal vein thrombosis (PVT). This study evaluated the association between catheter tip position and PVT in neonates. METHODS: We retrospectively analyzed 506 neonates who underwent UVC between 2014 and 2022. Catheter tip positions, determined by X-ray imaging, were classified into five categories (Type 1-5) using diaphragm/liver-based landmarks. Patient demographics, catheter dwell time, and thrombotic outcomes were evaluated. PVT was assessed by Doppler and/or grayscale ultrasonography. RESULTS: PVT was identified in 18 of 506 neonates (3.6%). The frequency of PVT differed significantly according to catheter tip position (p < 0.05), with a higher incidence observed in neonates with Type 3 (intrahepatic) and Type 5 (abnormal) catheter placement. Catheter dwell time was not significantly different between neonates with and without PVT. CONCLUSION: In this retrospective cohort, Type 3 and Type 5 UVC tip positions were associated with an increased frequency of PVT. These findings highlight the importance of careful catheter placement and imaging-based verification. Prospective studies are needed to better define optimal tip positioning and the independent role of catheter dwell time.