Prophylactic antibiotics in umbilical artery catheterization in the newborn

Over a period of 30 months, umbilical artery catheters were inserted in 229 infants. The main complications were haemorrhage, infection, and obstruction of a blood vessel. The incidence of infection was not affected by the use of prophylactic antibiotics. Vascular obstruction was more common in small infants, and in those in whom a catheter was reintroduced in the same blood vessel.     

False aneurysm of the descending aorta: a complication of umbilical artery catheterization

A patient had an aneurysm of the descending aorta secondary to aortitis arising from umbilical artery catheterization and in association with coarctation of the aorta. The aortitis probably was the direct result of bacterial contamination of the umbillicus and catheter with Staphylococcus aureus and the placement of the catheter tip just distal to a coarctation of the aorta. The patient required surgical resection of the coarctation and aneurysm of the descending aorta and placement of a tubular Dacron graft at 6 month of age. This is, to our knowledge, a hitherto unreported complication of umbilical artery catheterization.     

Peroneal nerve palsy: the role of early electromyography.

Footdrop is rare in the newborn period. In this report, the clinical and electrophysiological features of a newborn whose peroneal neuropathy was detected in the delivery room is presented. Her first electrophysiological examination, at the 13th hour of life, revealed a peroneal nerve lesion. All findings elicited in this and subsequent examinations suggested an antenatal onset. Clinical recovery began within weeks of the birth and she was able to walk, with no residual neurological abnormality, by her first birthday. Early electrophysiological examination of a newborn with peripheral neuropathy may provide valuable information about the time of onset and pathophysiological features of the nerve lesion. In spite of the early electromyogram findings revealing severe nerve injury, a good prognosis is possible in newborns with peroneal neuropathy.     

Hepatic laceration as a life-threatening complication of umbilical venous catheterization

Umbilical venous catheterization is an intravenous infusion route for maintenance fluids, medications, blood products, and parenteral nutrition in preterm neonates. However, this procedure may be associated with several complications, such as infection, thrombosis, vessel perforation, and cardiac and hepatic injuries. Hepatic laceration is a rare but life-threatening complication of umbilical venous catheterization that is a result of direct injury through the liver parenchyma. Here, we present a preterm newborn with hepatic laceration as a rare and serious complication of umbilical venous catheterization.     

Neonatal aortic thrombosis as a complication of umbilical artery catheterisation

Intensive management of the sick neonate demands aggressive monitoring involving access to the arterial system. This is usually accomplished using an umbilical artery catheter. Complications of this technique are well recognised and include infection, catheter embolism, neurological complications, necrotising enterocolitis, hypertension, arterial thrombosis, aortic aneurysm, and bleeding [6]. We report our experience of the diagnosis and treatment of aortic thrombosis secondary to umbilical artery catheterisation and outline several previously undiscussed points in its management. Offprint requests to: R. C. Kester at the above address