Background: Fat embolism is a phenomenon, occurring mostly in trauma as bone fractures and blunt
trauma. The use of bone needles in the emergency medicine led to the development of
studies regarding the incidence of fat embolism, which can occur in porcine model
in up to 30% of the cases. A single-center postmortem autopsy study in 20 pediatric
patients showed fat embolism after the use of bone needles in 8 of 13 cases and none
in the group without bone needles. Paradoxic embolism in neonates has been reported
in multiple case-reports, but until now there is a lack of controlled studies. Paradoxical
embolism can occur due to patent foramen ovale, patent arterial duct or persistent
pulmonary hypertension.
Method: We report the case of a 5-day-old newborn deteriorating in the obstetrics unit of
a second-level hospital and resuscitated under the use of a intraosseous fluid administration.
An initial echocardiographic examination depicted a severe myocardial dysfunction
with moderate mitral valve insufficiency. After admittance in the department of pediatric
cardiology under suspicion of cardiomyopathy or aortic coarctation a second echocardiographic
examination was performed, excluding a congenital heart defect but confirmed the severe
myocardial dysfunction. Additionally, a severe arterial hypertension with systolic
blood pressures up to 180 mm Hg was diagnosed without a systolic pressure Gradient
between upper and lower limb. Therefore, a kidney-ultrasound was performed revealing
a stenosis flow-pattern of the right renal artery. After medicated stabilization of
the blood pressure and inotropic support with the use of milrinone and urapidil, on
3rd day after admittance an angiographic examination was performed, showing multiple
fat embolisms in the right kidney arteries. These have been successfully removed by
aspiration embolectomy.
Conclusion: The bone needle is widely spread used as an alternative intravenous access in pediatric
patients and emergency medicine. In literature fat lung-embolism is described in up
to 62% of patients after the use bone-needle. In the use of bone needle for resuscitation
in neonates, paradoxic fat embolism at the level of patent arterial duct and patent
foramen ovale and its adverse sequel should be considered.
