Pediatrics Residency Program, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Transitional Year Residency Program, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
S D Med. 2021 Dec;74(12):554-558.
Extravasation of total parenteral nutrition (TPN) from a malpositioned umbilical venous catheter (UVC) is a rare cause of ascites in neonates. The gross appearance of the aspirated peritoneal fluid may mimic congenital chylous ascites, delaying an accurate diagnosis of the causative source. UVC malpositioning is associated with complications of various organs as related to the position of the UVC tip. TPN from laterally positioned UVC tips may penetrate into the liver and provoke hepatic damage with subsequent peritoneal fluid accumulation. Factors including biochemical characteristics of the peritoneal fluid, radiographic findings with specific attention to the location of the UVC tip, and clinical timing of ascites presentation have been associated with TPN extravasation from UVCs. This report presents a case of a preterm neonate with intraperitoneal extravasation of TPN and associated hepatic hemorrhage due to a malpositioned UVC while highlighting the cumulative clinical, radiographic, and laboratory findings that should prompt consideration of this complication as the cause of ascites in neonates.
肠外营养（TPN）外渗是新生儿腹水的一个罕见原因，这种情况通常是由于脐静脉导管（UVC）位置不当导致的。抽吸的腹腔液外观可能类似于先天性乳糜性腹水，从而延误了对病因的准确诊断。UVC 位置不当与 UVC 尖端位置相关的各种器官并发症有关。UVC 尖端侧向放置的 TPN 可能会穿透肝脏并引起肝损伤，随后导致腹腔液积聚。与 UVC 外渗相关的因素包括腹腔液的生化特征、特定注意 UVC 尖端位置的影像学发现以及腹水出现的临床时间等。本报告介绍了一例因 UVC 位置不当导致 TPN 腹腔内外渗和相关肝出血的早产儿病例，突出了累积的临床、影像学和实验室发现，这些发现应促使考虑将此并发症作为新生儿腹水的病因。
