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 16th 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
2nd hour of life, and by the 3rd day of life, the
infant transitioned to minimal enteral feeding. Between the 12th and
16th 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
