Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters

Abstract

While low UVC placement may sometimes be clinically unavoidable, TPN administered through abnormally positioned UVCs is not without risk.

An umbilical venous catheter complication presented as acute abdomen. Case report

“…In such cases the radiologist has an important role to alert the pediatrician. 1 In our case, the tip of the UVC was located at T10 on radiograph and this situation has not been identified as inadequate by the physicians, therefore, nobody modified the catheter before to start with the parenteral nutrition.…”

“…Many systemic but also local complications has been reported like hepatic laceration, hepatic collection, ascites, hepatic abscess formation, hepatic necrosis and vessel perforation after low placed UVCs. 1,5,6,11 The length of using time of UVC may also related to the development of complications associated with the liver. 11 The direct administration of TPN to liver may cause damage to the parenchyma of the liver and in time liver capsule get disrupted from this area causing free extravasation of TPN.…”

“…1 It is used for intravenous fluid and drug administration, parenteral nutrition and exchange transfusion. 2 This procedure in neonates is not always uneventful.…”

Letters to the Editor

“…As there was no obvious communication demonstrated on ultrasound this may not have been a simple hole. It could have been due to a very small area of local hepatic necrosis caused by the TPN, which has been described, 6 or by the two bicarbonate infusions. Another possibility is trauma to the umbilical vein from the original intrauterine transfusions, or postnatal catheter insertions.…”

“…5 and superior vena cava (SVC) obstruction and ascites. [6][7][8] We report a case of ascites from parenteral nutrition fluid in a preterm baby with an UVC. A female infant was born by emergency Caesarean section at 28 weeks' gestation weighing 1488 g. She had severe fetal bradycardia during an intrauterine blood transfusion for isoimmunisation due to anti-Kell and anti-E antibodies when the needle was dislodged from the cord by fetal movement.…”