Umbilical Catheter Extravasation Mimicking Necrotizing Enterocolitis in a Preterm Neonate: A Diagnostic Challenge

Abstract

Managing acute abdomen in very low birth weight (VLBW) and premature infants presents a diagnostic challenge, often necessitating a thorough assessment to discern underlying causes. Umbilical venous catheters (UVCs), commonly used in neonatal intensive care, are essential but not without risks. A 29-week premature male infant, born to a 23-year-old mother, was referred to our clinic on the 16^th day of life with a suspected diagnosis of necrotizing enterocolitis (NEC). The infant had spent the first day intubated and received non-invasive respiratory support for 15 days. A 5 French UVC was inserted at the 2^nd hour of life, and by the 3^rd day of life, the infant transitioned to minimal enteral feeding. Between the 12^th and 16^th days of life, the infant initially diagnosed with NEC due to symptoms such as decreased stool passage and abdominal distension. The patient had been on a continuous course of antibiotic treatment throughout the entirety of his life, commencing on the very first day due to suspected early neonatal sepsis, followed by nosocomial sepsis during the hospitalization, and persisting with antibiotic therapy for suspected NEC. The case took a unique turn upon further evaluation after being referred to our unit. Despite a preliminary NEC diagnosis, further evaluation revealed umbilical catheter complications, leading to total parenteral nutrition extravasation. Removal of the catheter, drainage, and antibiotic adjustment resulted in improved clinical outcomes. In neonatal care, cautious management is vital when dealing with infants exhibiting abdominal symptoms. A nuanced approach, including differential diagnosis and careful antibiotic use, is essential.

Keywords

Umbilical venous catheter - abdominal distension - diagnostic challenges - preterm

Publikationsverlauf

Eingereicht: 12. Januar 2024

Angenommen: 15. März 2024

Artikel online veröffentlicht:
06. Mai 2024

• References

• 1 Ergenekon E, Tayman C, Özkan H. Turkish Neonatal Society Necrotizing Enterocolitis Diagnosis, Treatment and Prevention Guidelines. Turk Arch Pediatr 2021; 56: 513-524
• 2 McIntyre C, August D, Cobbald L. et al. Neonatal vascular access practice and complications: An observational study of 1,375 catheter days. J Perinat Neonatal Nurs 2023; 37: 332-339
• 3 Chen HJ, Chao HC, Chiang MC. et al. Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience. Pediatr Neonatol 2020; 61: 16-24
• 4 Reyman M, van Houten MA, Watson RL. et al. Effects of early-life antibiotics on the developing infant gut microbiome and resistome: a randomized trial. Nat Commun 2022; 13: 893
• 5 Gordon A, Greenhalgh M, McGuire W. Early planned removal of umbilical venous catheters to prevent infection in newborn infants. Cochrane Database Syst Rev 2017; 10: CD012142
• 6 Oztan MO, Ilhan O, Abay E. et al. An umbilical venous catheter complication presented as acute abdomen: case report. Arch Argent Pediatr 2016; 114: e429
• 7 Kowalczyk AO, Bhogal J, Surak A. Point-of-care ultrasound aided diagnosis and management of peritoneal parenteral nutrition extravasation in a preterm baby: A case report. Clin Case Rep 2023; 11: e7563
• 8 Ramaswamy VV, Rao GV, Suryanarayana N. et al. Parenteral nutrition extravasation associated liver injury – A case series with varying clinical-radiological presentations. J Pediatr Neonatal Individual Med (JPNIM) 2019; 9: e090102
• 9 Shareena I, Khu YS, Cheah FC. Intraperitoneal extravasation of total parental nutrition infusate from an umbilical venous catheter. Singapore Med J 2008; 49: e35-e36
• 10 Pegu S, Murthy P. Ascites with hepatic extravasation of total parenteral nutrition (TPN) secondary to umbilical venous catheter (UVC) malposition in an extremely preterm baby. BMJ Case Rep 2018; 2018
• 11 Panetta J, Morley C, Betheras R. Ascites in a premature baby due to parenteral nutrition from an umbilical venous catheter. J Paediatr Child Health 2000; 36: 197-198
• 12 Majid A, Barrett J, Meyer MPJR. et al. Acute management of intraperitoneal extravasation of total parenteral nutrition (TPN) in a very preterm ınfant: case report and literature review. Res Rep Neonatol 2021; 11: 77-81
• 13 Sztajnbok J, Troster EJ. Acute abdomen due to late retroperitoneal extravasation from a femoral venous catheter in a newborn. Sao Paulo Med J 2002; 120: 59-61
• 14 Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F. et al. Catheter tip position and risk of mechanical complications in a neonatal unit. An Pediatr (Barc). 2016. 85. 77-85
• 15 Cao J, Zhang Y, Yin Y. et al. Accuracy of chest radiography compared to ultrasound for positioning the umbilical venous catheter in neonates: A meta-analysis and systematic review. J Vasc Access 2023; 24: 1051-1060
• 16 D’Andrea V, Prontera G, Rubortone SA. et al. Umbilical venous catheter update: A narrative review ıncluding ultrasound and training. Front Pediatr 2022; 9: 774705