Sterile Hepatic Abscess Secondary to Administration of Parenteral Fluids Via an Umbilical Venous Catheter in a Premature Baby

Severe Liver Injury while Using Umbilical Venous Catheter: Case Series and Literature Review

“…19 Our literature review revealed 19 reports that included 32 cases of hepatic injury by UVCs in which the position of the UVC tip, at insertion and/or at the time of diagnosis, was evaluated by TARs (►Table 2). [1][2][3][4][5][6][7][8][9][10][11]14,[23][24][25][26][27]33,34 In 27 neonates, the catheter tip was initially placed lower than recommended, whereas in 5 neonates the tip was at the recommended level. 4,9,26,27 However, at the time of the liver injury diagnosis, even in those five neonates, the UVC tip was below the radiographic level of the right diaphragm.…”

“…[2][3][4][5][6][7][8][9]24 Most typically, the intraperitoneal fluid represents extravasated TPN, which may be hemorrhagic. 2 Other presentations include hypotension, [2][3][4][5][6]8,24,26 worsening respiratory distress, [2][3][4][5][8][9][10]14,26,33,34 anemia, 3,8,24,26,27 fatal hemorrhagic shock, 3,24,27 anuria, 11 sepsis or hepatic abscess, 4,5,13,33 acute liver hematoma, 24,35 and portal thrombosis with chronic portal hypertension. 13,22,36 In six of our nine neonates, hemorrhagic shock or severe anemia developed secondary to bleeding into the cystic liver lesion.…”

“…20 The most frequently reported invasive interventions in neonates with UVC associated liver complication were paracentesis for large ascites, and surgical drainage especially when large hepatic cyst compromises portal circulation. [2][3][4][5][6][7][8][9][10][11]14,[24][25][26][27]33,34 Clinical presentation of liver injury may mimic necrotizing enterocolitis which may trigger exploratory laparotomy, 5,24 as was the case in one of our neonates.…”

Parenteral nutrition therapy for neonates: Experience in a tertiary care centre in Sri Lanka

“…Due to the increased rate of complications associated with umbilical catheter use in PN administration, many neonatal units prefer to use percutaneous intravenous catheters (PIC) for PN 14 . Though placing PIC is potentially difficult, it has a better delivery of nutrition and is more stable than peripheral cannula and is less associated with invasive infections than peripheral cannula 15,16 .…”

Positioning newborns on their back or right side for umbilical venous catheter insertion

“…because of the risk of portal or hepatic vein thrombosis, hepatic abscess formation, necrosis and laceration (11)(12)(13)(14)(15)(16).…”