Indwelling umbilical arterial catheter: a preferred sampling site for blood culture

Indwelling umbilical arterial catheter was evaluated prospectively as an alternative site for blood culture sampling. In 282 infants, 318 paired blood cultures were obtained from the peripheral vein and from the indwelling umbilical arterial line. Duration of umbilical catheter placement ranged from 0.5 to 196 hours; in 17% of the infants, catheters were in place for between 24 and 196 hours. In 13 blood culture pairs the same pathogens were found and had been obtained from the peripheral vein and the umbilical arterial line. Two pairs were positive for discrepant organisms. A total of 11 pairs were positive in one site only, with five positive from peripheral vein only and the other six from the umbilical arterial catheter. However, most of these single-site positive blood cultures were apparently true positives based on supporting laboratory data for infection. Contamination rates were 1.3% and 0.9% for peripheral vein and umbilical arterial catheter blood cultures, respectively. Thus, in sick neonates, the indwelling umbilical arterial line was an alternative and perhaps a preferred site for blood culture sampling.     

Exchange transfusion in newborns via a peripheral artery and vein

Exchange transfusion using a peripheral artery and vein was carried out 18 times in 17 newborn infants. The arteries used to withdraw blood were the radial [13], the ulnar [3] and the posterior tibial [2]. Infusion of blood was carried out simultaneously through a peripheral vein. There was no mortality or morbidity directly associated with the procedure. We recommend this technique for exchange transfusion in general, and especially in the very ill newborn.     

Pediatric emergency intravenous access. Evaluation of a protocol

Effectiveness of a protocol for intravenous (IV) access during pediatric resuscitation was prospectively evaluated to determine whether utilization of a specified sequence of measures would reduce IV access time compared with resuscitations deviating from the protocol. The protocol involved rapid sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous infusions if initial percutaneous peripheral IV insertion failed. While no single technique provided completely reliable and rapid IV access, utilization of all techniques per protocol significantly improved IV access time. When initial percutaneous peripheral IV attempts failed, resuscitations in compliance with the protocol achieved IV access more rapidly (median, 4.5 minutes) than those deviating from the protocol (median, 10.0 minutes). Even with incomplete compliance, 66% of resuscitations achieved IV access within the first five minutes. Our experience indicates that IV access during pediatric resuscitation should rarely be delayed beyond the fifth minute if all available IV techniques are used.     

Diagnosis of neonatal bacteremia by a microblood culture technique: A preliminary report

A method is described for obtaining blood by heel-stick from high-risk neonatal infants for bacteriologic studies. Results of culture of blood collected by heel-sick are compared to those of simultaneously drawn blood from a peripheral vein. The data obtained suggest that this method may be a useful adjunct in the close surveillance for bacteremia in high-risk neonates.     

Plasma Atrial Natriuretic Polypeptide Concentration in Healthy Children from Birth to Adolescence

ABSTRACT. We measured plasma atrial natriuretic polypeptide concentrations in the umbilical artery and vein, and peripheral veins of healthy children from birth to adolescence to establish the normal range. The plasma atrial natriuretic polypeptide concentration in the umbilical artery (mean±SD, 51.0±21.4 fmol/ml) was significantly higher than that in the umbilical vein (18.1±13.5 fmol/ml) in neonates after vaginal delivery. Also neonates aged 5 days or less had a significantly high concentration in the peripheral vein (60.7±29.4 fmol/ml). There was no significant difference in atrial natriuretic polypeptide concentrations in the peripheral veins between older children and adults. The concentrations in children aged more than 5 days and adults aged 20–34 years were 14.4±7.4 fmol/ml and 10.0±4.8 fmol/ml, respectively. However, the atrial natriuretic polypeptide concentration in the umbilical artery was not increased in three neonates delivered by caesarean section although they had a high concentration in the peripheral vein 24 hours after birth.     

Cortisol and estradiol secretion by a benign virilizing adrenocortical tumor in a prepubertal girl

We report a 5.5 year-old girl with a benign adrenocortical adenoma who presented with virilization and rapid growth. She did not have any clinical features of isosexual precocity or, except for hypertension, Cushing's syndrome. Measurement of hormones in adrenal vein blood obtained at surgery showed high concentrations of testosterone, cortisol, estradiol and intermediary substrates. Elevated levels of hormones detected in the peripheral blood were released directly from the tumor and were not the result of peripheral interconversion. Hyperandrogenism can obscure the clinical features of Cushing's syndrome and estrogen hypersecretion in patients with functional adrenal tumors.     

Infections related to vascular catheters in a pediatric intensive care unit

We determined the rate and risk factors for colonization of 103 peripheral intravenous catheter and 32 central venous catheters. 52.5% peripheral catheters had colonization. Common organisms isolated were Pseudomonas (33.3%) and coagulase negative Staphylococci (29.6%). Colonization was higher in catheters inserted in the lower limb. Overall 62.5% of the central catheters were colonized, chiefly by coagulase negative Staphylococci, Pseudomonas and Candida. All central catheters in place for more than 11 days were colonized. Subclavian vein catheters had a higher rate (68.2%) of colonization in comparison to femoral vein insertions (40%). We conclude that upper limb placements are preferable to lower limbs when using peripheral lines. Changing peripheral intravenous catheters every 48 hours and central venous catheters every 10 days may decrease the rate of colonization.     

COMPARISONS BETWEEN SERUM CONCENTRATIONS OF THYROXINE AND THYROXINE-BINDING PROTEINS IN SAMPLES SIMULTANEOUSLY OBTAINED FROM CAPILLARY, PERIPHERAL VEIN, CENTRAL VEIN AND AORTA IN NEWBORN INFANTS

Abstract. Jacobsen, B. B. and Peitersen, B. (University Clinic of Paediatrics, Children's Hospital, Fuglebakken, Copenhagen, Denmark). Comparisons between serum concentrations of thyroxine and thyroxine-binding proteins in samples simultaneously obtained from capillary, peripheral vein, central vein and aorta in newborn infants. Acta Paediatr Scand, 68: 43, 1979.—A total number of 40 newborn infants with various maturity were studied: 13 babies without perinatal events, 19 infants recovered from transient diseases, 6 infants with idiopathic respiratory distress syndrome and 2 infants with asphyxia indicating artificial ventilation. Comparisons were performed between serum concentrations of thyroxine (T₄), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) in capillary versus peripheral vein, aorta versus central vein and, finally, in peripheral versus central veins. In healthy infants serum T₄ concentrations in capillary blood and peripheral vein did not differ significantly. Although serum concentrations of thyroid hormone-binding proteins tended to be increased in aortic compared to central venous specimens no statistically significant differences appeared. In infants in good clinical conditions serum T₄, TBG, TBPA, and Alb levels were 6–8% higher in peripheral than in central veins, possibly primarily due to a hemo-concentrating effect of venous stasis. Therefore, in evaluation of the thyroid variables in newborn infants the technique of blood sampling must be considered. In most infants with idiopathic respiratory distress syndrome and in one asphyxiated baby a remarkable tendency to a low serum TBG and T₄ concentration in peripheral compared to central vein samples, were observed.     

Plasma atrial natriuretic polypeptide concentration in healthy children from birth to adolescence

We measured plasma atrial natriuretic polypeptide concentrations in the umbilical artery and vein, and peripheral veins of healthy children from birth to adolescence to establish the normal range. The plasma atrial natriuretic polypeptide concentration in the umbilical artery (mean +/- SD, 51.0 +/- 21.4 fmol/ml) was significantly higher than that in the umbilical vein (18.1 +/- 13.5 fmol/ml) in neonates after vaginal delivery. Also neonates aged 5 days or less had a significantly high concentration in the peripheral vein (60.7 +/- 29.4 fmol/ml). There was no significant difference in atrial natriuretic polypeptide concentrations in the peripheral veins between older children and adults. The concentrations in children aged more than 5 days and adults aged 20-34 years were 14.4 +/- 7.4 fmol/ml and 10.0 +/- 4.8 fmol/ml, respectively. However, the atrial natriuretic polypeptide concentration in the umbilical artery was not increased in three neonates delivered by caesarean section although they had a high concentration in the peripheral vein 24 hours after birth.     

Comparisons between serum concentrations of thyroxine and thyroxine-binding proteins in samples simultaneously obtained from capillary, peripheral vein, central vein and aorta in newborn infants.

A total number of 40 newborn infants with various maturity were studied: 13 babies without perinatal events, 19 infants recovered from transient diseases, 6 infants with idiopathic respiratory distress syndrome and 2 infants with asphyxia indicating artificial ventilation. Comparisons were performed between serum concentrations of thyroxine (T4), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) in capillary versus peripheral vein, aorta versus central vein and, finally, in peripheral versus central veins. In healthy infants serum T4 concentrations in capillary blood and peripheral vein did not differ significantly. Although serum concentrations of thyroid hormone-binding proteins tended to be increased in aortic compared to central venous specimens no statistically significant differences appeared. In infants in good clinical conditions serum T4, TBG, TBPA, and Alb levels were 6--8% higher in peripheral than in central veins, possibly primarily due to a hemo-concentrating effect of venous stasis. Therefore, in evaluation of the thyroid variables in newborn infants the technique of blood sampling must be considered. In most infants with idiopathic respiratory distress syndrome and in one asphyxiated baby a remarkable tendency to a low serum TBG and T4 concentration in peripheral compared to central vein samples were observed.     

Total Anomalous Pulmonary Venous Return with the Circular Pulmonary Venous Connection: Outcome of Common Pulmonary Venous Agenesis

A rare case of total anomalous pulmonary venous return, in which the right and left peripheral pulmonary veins connected circularly and there was no central part of the pulmonary vein or the common pulmonary vein, is presented. To our knowledge, total anomalous pulmonary venous return with circular pulmonary venous connection has not been reported previously in the literature. It is thought that the complex connection between peripheral pulmonary veins with the absence of the central part of the pulmonary vein as well as the common pulmonary vein results from common pulmonary venous agenesis.     

Frequency of portal and systemic bacteremia in acute appendicitis

BACKGROUND: Acute appendicitis is the most common condition requiring an emergency abdominal operation in childhood. In the present study, we analyzed the frequency of portal and systemic bacteremia in 42 patients with acute appendicitis and determined the microbial agents responsible for an acute appendicitis and for portal and systemic bacteremia. METHODS: Appendectomies were performed on 50 young patients (5-18 years of age), as well as clinical and bacteriological tests. Six independent samples from each patient isolated from the peripheral vein, superior mesenteric vein, appendix and peritoneum were obtained prior to surgery, during surgery and after surgery for biochemical, immunologic and bacteriologic examination. RESULTS: Pathohistology confirmed the diagnosis of appendicitis in 42 patients, while in the other eight patients there were no obvious pathologic findings, so they served as a control group. Of 50 patients with a clinical appearance of acute appendicitis, in 19 patients (38%) we detected portal bacteremia in the mesenteric vein, while in only three cases (6%) did we find systemic bacteremia detected from the peripheral vein. Furthermore, bacteriologic analysis revealed that Bacteroides spp. and Escherichia coli were the predominant species isolated. CONCLUSIONS: The results presented in this paper suggests that portal bacteremia did not influence peripheral blood reactions. Furthermore, in the present study we have found a positive correlation between the smear and bacteremia of the superior mesenteric vein, but not with the bacteremia of systemic blood.     

Liver transplantation for a hilar inflammatory myofibroblastic tumor

A 7-yr-old boy presented with obstructive jaundice secondary to an inflammatory myofibroblastic tumor centered on the hepatic hilum and extending into the liver. The tumor was further complicated by portal vein phlebitis and occlusion. Attempted resection of the tumor with portal vein reconstruction and bilioenteric drainage was unsuccessful and he required urgent orthotopic liver transplantation. In contrast to more peripheral inflammatory myofibroblastic tumors in the liver, hilar lesions are locally aggressive, causing occlusive portal phlebitis and biliary obstruction. Successful management may include the need for liver transplantation.     

Peripheral inflammatory pseudotumor of the liver and extensive thrombosis of the portal venous system in a child

We report a case of a peripheral inflammatory pseudotumor of the right lobe of the liver with extensive thrombosis of the portal venous system in a 9-year-old boy. Local thrombosis of the portal vein is a known complication of the inflammatory pseudotumor, especially in the hepatic hilum. The extent of the thrombosis in this case was unexpected, considering the peripheral location and the benign nature of the lesion. To our knowledge, thrombosis of this degree has not been described.     

Thrombotic lesions of the tricuspid valve in a newborn: Surgical management

Summary Thrombotic lesions on the leaflets of the tricuspid valve in a premature infant with an anatomically normal heart are described. The diagnosis was made by two-dimensional and Doppler echocardiography. No etiologic explanation could be obtained from the history and clinical findings. The newborn had no infection, no antithrombin deficiency, and no indwelling catheter through either a peripheral, central or umbilical vein. The multiple masses were successfully removed by surgery under deep hypothermic circulatory arrest at 1 month of age. The child is well, without neurological deficit, and is developing normally.     

Supply of vitamin A, E, C, B 12 and folates during total parenteral nutrition in pediatrics]

Serum vitamin A, vitamin E, vitamin B12, folate and leucocyte vitamin C were measured in 45 patients between the ages of one month and 2 1/2 years who were receiving total parenteral nutrition. After allowing for variations in intake the following recommendations are made: Vitamin A (central vein) 2,500 i.u./day (peripheral vein) 1,000 - 1,500 i.u./day. Vitamin E (peripheral vein) 0.8 mg/kg/day, Vitamin B12 (central vein) 0.8 - 1 microgram/day, Folate (central vein) 10 - 80 microgram/day, Vitamin C (central vein) 25 mg/day.     

Evaluation of percutaneously inserted peripheral silicone catheters for parenteral nutrition in infants and children

Delivery of long term parenteral nutrition (PN) to small infants and children by peripheral vein effectively reduces: he risk of serious cather-related complications which may occur with central vein delivery, but provides the practical difficulties of repeated vein puncture, limited vein access and the problems of phlebitis and extravasation. This study evaluates the use of percutaneous peripheral indwelling fine silicone catheters, compared with conventional methods of delivery in 20 patients (median age 0.2 years) requiring PN for 521 patient-days (average, 26). These catheters compared favourably with other peripheral insertions in terms of mean indwelling time (12,6 ± 2.0 vs 1.3 ± 0.2 days, p<0.001), frequency of insertions required (7.9 vs 75 insertions per 100 patient-days) and local complications (2.6 episodes per 100 days — mild phlebitis only — vs 65 per 100 days). Fewer serious complications were encountered than with the centrally placed catheters, the major complication rate of 0.3 per 100 patient-days being due to a single possible episode of sepsis. We conclude that this technique offers significant practical advantages over conventional PN delivery for small infants and children, by reducing the frequency of venipuncture, prolonging vein life and vein access, reducing work load, and eliminating extravasation, with a minimum of serious complications.     

小儿门静脉海绵样变性的外科治疗

目的 探讨小儿门静脉海绵样变性的外科治疗方法。方法 总结收治的16例小儿门静脉海绵样变性病例的临床表现、彩色多普勒的影像特征及手术中所见、实施手术的方法和效果。结果 首发症状多为呕血、便血，少数表现为顽固性贫血，脾脏肿大是其重要体征，均经彩色多普勒获得明确诊断。16例均行脾切除、贲门周围血管离断术有14例另加不同的分流手术。脾-肾分流手术适用于大多数门静脉海绵样变性的患儿，年龄及肾血管的直径不一定是限定手术的条件。术后随访显示患儿贫血纠正，上消化道出血明显改善。彩色多普勒显示分流处血流通畅。结论 该病治疗以手术治疗为主，在脾切除、贲门周围血管离断术的基础上，分流术可以获得良好的效果。     

Calcified neonatal renal vein thrombosis demonstration by CT and US

Two cases of calcified renal vein thrombosis (RVT) were diagnosed, incidentally, within the first weeks of life. The CT images present the virtually diagnostic branching pattern of calcification that has been previously noted on pathology specimen radiographs. The CT and US images show peripheral renal vein, central renal vein and inferior vena cava calcification conforming to the two theoretical origins of intravascular calcification. The patients had normal laboratory results and no symptoms related to renal vein or inferior vena cava thrombi.     

Partial exchange transfusion in term, polycythemic neonates: absence of association with severe gastrointestinal injury

Partial exchange transfusion is often used to treat neonatal polycythemia. Concern about the risk of necrotizing enterocolitis following the procedure has recently been raised. We report a retrospective analysis of 185 term, polycythemic neonates who received partial exchange transfusion. No evidence of severe gastrointestinal injury was found. The technique for partial exchange transfusion we report consists of removal of blood from the umbilical vein with reinfusion of a commercial plasma substitute through a peripheral vein. Based on our data and a literature review, we offer suggestions for future conduct of partial exchange transfusion in polycythemic neonates.