Neonatal Portal Vein Thrombosis: A Retrospective Study of Management and Follow-Up at One Institution

Management of neonatal portal vein thrombosis (PVT), a relatively common type of pediatric deep vein thrombosis, is not completely standardized. Questions remain about the benefit of anticoagulation (ATC) therapy and about the optimal frequency and duration of doppler ultrasound (US) surveillance for liver complications such as portal hypertension and gastrointestinal bleeding. Current guidelines suggest reserving ATC only for occlusive PVT, highlighting a need for explicit grading of PVT in radiologic reports and a consensus approach to imaging and management.

To address these issues, we implemented an institutional Neonatal PVT Management Algorithm using plan-do-study-act (PDSA) methodology. We aimed to standardize screening tests, reduce unnecessary ATC, and optimize imaging checkpoints. A five-year retrospective review established baseline data, which we compared to outcomes five years post-implementation of the algorithm.

The algorithm recommended ATC only for occlusive PVT and advised US imaging at Week 1, Month 1, Month 3, and Month 6 from diagnosis, with annual surveillance for unresolved or abnormal cases. Post-implementation analysis revealed improvements in radiologic documentation of PVT grading, a reduction in the use of ATC for subocclusive PVT, and a decrease in the median duration of ATC for all patients. Follow-up imaging adherence did not improve between the pre- and post-implementation periods.

The algorithm successfully enhanced documentation of PVT grading and reduced unnecessary ATC but highlighted persistent challenges in follow-up adherence, suggesting a need for further refinement in future PDSA cycles.