Hemidiaphragmatic paralysis in preterm neonates: a rare complication of peripherally inserted central catheter extravasation

J Pediatr Surg. 2011 Jul;46(7):E17-21. doi: 10.1016/j.jpedsurg.2011.03.065.

Abstract

Unilateral diaphragmatic paralysis was diagnosed in 2 preterm neonates born at 29 and 25 weeks of gestation, respectively. In both instances, the pathophysiology was phrenic nerve injury after extravasation of parenteral nutrition fluid. Misplacement and infection were predisposing factors. Diaphragmatic movement analysis by time-motion-mode ultrasonography was helpful in achieving a diagnosis. The first neonate required a diaphragmatic placation, whereas the other infant was managed nonoperatively. These cases confirm a rare etiology of diaphragmatic paralysis and possible spontaneous recovery. In neonates with very low birth weight, general anesthesia and thoracic surgery may be associated with a high morbidity, suggesting that nonoperative medical treatment, when possible, is preferable if the neonate does not require supplemental oxygen.

Publication types

  • Case Reports

MeSH terms

  • Bronchopulmonary Dysplasia / complications
  • Catheter-Related Infections / complications
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Peripheral / adverse effects*
  • Contrast Media / administration & dosage
  • Contrast Media / adverse effects*
  • Diffusion
  • Extravasation of Diagnostic and Therapeutic Materials / complications*
  • Heart Atria
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / diagnostic imaging
  • Infant, Premature, Diseases / etiology*
  • Magnetic Resonance Imaging
  • Male
  • Osmolar Concentration
  • Parenteral Nutrition Solutions / administration & dosage
  • Parenteral Nutrition Solutions / adverse effects*
  • Phrenic Nerve / drug effects
  • Phrenic Nerve / injuries*
  • Respiratory Distress Syndrome, Newborn / complications
  • Respiratory Paralysis / diagnostic imaging
  • Respiratory Paralysis / etiology*
  • Respiratory Paralysis / surgery
  • Shock, Septic / complications
  • Staphylococcal Infections / complications
  • Staphylococcus epidermidis
  • Thoracotomy
  • Ultrasonography
  • Vena Cava, Superior

Substances

  • Contrast Media
  • Parenteral Nutrition Solutions