Aim: Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia. Methods:The cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1À39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system.Results: In term newborns, diameter of the cortex of the proximal humeral head is 12.1 AE 1.8 mm, distal end of the femur 11.9 AE 3.4 mm and the proximal tibial bone 12.0 AE 2.4 mm with cross-sectional diameter of 113.5 AE 19.7 mm 2 , 120.6 AE 28.2 mm 2 and 111.6 AE 29.5 mm 2 , respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds. Conclusion:Proximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.

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Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. Eighteen stillborns were investigated (29.2 weeks ± 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV. We measured the diameter at the narrowest points of (i) the umbilical vein, (ii) the segmental portal vein, (iii) the left portal vein, (iv) the umbilical recess, and (v) the ductus venosus. The branching angles between (a) the umbilical vein and intrahepatic veins and (b) the ductus venosus and umbilical recess were measured. The diameter of the UV increases from 3.4 to 11 mm (median [IQR]:4.6 mm [4.2-6.9]: r = 0.64). The left portal vein has a larger diameter (3.6 mm [2.6-4.55]; r = 0.43) than the left segmental portal vein (2.3 mm [1.8-2.75]; r = 0.23). The diameter of the ductus venosus (2.5 mm [1.6-3.4]; r = 0.59) is half that of the umbilical recess (5.1 mm [3.3-6.2]; r = 0.43). The most obtuse angle is formed by the junction between the umbilical recess and ductus venosus (151° [133-159]; r = 0.001). The branch angle from the outgoing UV into the left portal vein is more obtuse (128° [123-144]; r = 0.0001) than that of the segmental portal vein (115° [105-119]; r = 0.0001). To avoid mal-positioning, our data suggest the use of a soft catheter. The UV and its extensions are wide enough to admit a 4 Fr. catheter without complete obstruction. Clin. Anat. 31:269-274, 2018. © 2017 Wiley Periodicals, Inc.

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