Carol Trotter

Inadvertent catheterization of the ascending lumbar vein.

A NUMBER OF SERIOUS COMPLICATIONS can arise from malpositioned central venous catheters (CVCs), including cardiac tamponade and perforation, pleural effusions, and infusion into the vertebral venous system anywhere along the spinal column. Figure 1 is an x-ray of a premature infant taken after insertion of a 2.0 Silastic peripherally inserted central catheter (PICC), demonstrating the catheter entering the left ascending lumbar vein (ALV). Routine contrast injection of 0.3 mL of iothalamate meglumine 60 percent (Conray, Covidien Imaging Solutions, Hazelwood, Missouri) at the time of the PICC-placement film demonstrated that the contrast material extended into the vertebral venous plexus. The catheter was immediately withdrawn before intravenous fluid was administered, and the infant experienced no complications.

Pneumothorax in the neonate: assessment and diagnosis.

PNEUMOTHORAX OCCURS MORE often in the neonatal period than at any other time of life.1 It can happen spontaneously, secondary to mechanical ventilation, as a complication following certain procedures, or as a result of pneumonia or aspiration.2 The frequency of spontaneous pneumothorax is approximately 1 percent of all live births.1 Horbar and colleagues reported data on 118,448 very low birth weight newborns (410–1,500 gm) followed through the Vermont Oxford Network from 1991 to 1999. They documented an increasing risk for pneumothorax with time. Rates of pneumothorax for neonates with birth weights of 501–750 gm were as high as 14 percent in 1999.3 The following case study summarizes the course of a neonate with a recurrent tension pneumothorax.

Why are we trimming peripherally inserted central venous catheters

PERIPHERALLY INSERTED CENTRAL venous catheters (PICCs) are used as the standard of care for longterm intravenous access in neonates treated in neonatal intensive care units. Little evidence supports many of the practices associated with PICC lines, however. Some practices needing more evidence include catheter tip placement in very low birth weight neonates, the catheter insertion site, the catheter material, insertion site dressings, and mechanisms to prevent catheter-related sepsis. Of particular concern is the practice of trimming the excess length off the distal end of the catheter prior to insertion.

Radiology basics, Part II: RDS and BPD.

ASSESSMENT OF ADEQUACY OF INSPIRATORY EFFORT IS essential in the evaluation of a chest roentgenogram. Underinflation of the chest may suggest serious cardiac or pulmonary disease or worsening of the existing condition.1 Therefore it is essential that adequacy of inspiration is provided for when chest x-ray films are taken.

Posthemorrhagic hydrocephalus: a complication of intraventricular hemorrhage.

SURVIVAL OF PREMATURE AND LOW birth weight (LBW) neonates has increased in the past decade, and it continues to improve with recent advances in neonatal care. The use of antenatal corticosteroids and surfactant has played a major role in the improved survival of these LBW infants. Stevenson and colleagues documented survival-to-discharge rates of 49 percent for infants weighing 501–750 gm at birth, 85 percent for those 751–1,000 gm, 93 percent for those 1,001–1,250 gm, and 96 percent for those 1,251–1500 gm. With increasing survival rates, developmental outcome remains a concern, particularly in the lowest birth weight groups. Approximately 32 percent of very low birth weight (VLBW) infants (defined as weighing 501–1,500 gm) show evidence of intracrenial hemorrhage.

Radiology Basics, Part VI: Pulmonary Sequestration, Periventricular/Intraventricular Hemorrhage, Embolization of Percutaneous Central Venous Catheters

THE CLINICIAN FREQUENTLY DEALS WITH INFANTS WHO present with respiratory distress and/or abnormal chest x-ray findings of undetermined etiology. One of the essential components in the process of patient evaluation is consideration of differential diagnosis with correlation to radiologic findings and clinical presentation. Sequestrations are estimated to account for 0.15–1.7 percent of all congenital pulmonary malformations.1 Although rare, often asymptomatic, and frequently not presenting in the neonatal period, pulmonary sequestrations or bronchovascular foregut malformation anomalies (with or without respiratory distress) can result in abnormal radiographic findings and should be considered in the differential diagnosis.

Radiology Basics, Part III: TTN, Meconium Aspiration, and Neonatal Pneumonia

R ETAINED LUNG FLUID, ALSO KNOWN AS TRANSIENT tachypnea of the newborn, was first described as a syndrome by Mary Ellen Avery in 1966.1 Other names that have been applied to this problem are wet lung syndrome and respiratory distress syndrome Type II. It is a diagnosis of exclusion and is generally a benign, self-limiting condition of the term or near-term neonate lasting 24 to 48 hours and occasionally up to 72 hours. The most prominent findings are tachypnea with respiratory rates as high as 120 per minute, grunting, nasal flaring, minimal to no retractions, minimal cyanosis, and mild hypoxemia. The onset of clinical findings appears soon after birth or at birth. Both the clinical and x-ray findings resolve within 72 hours.RETAINED LUNG FLUID, ALSO KNOWN AS TRANSIENT tachypnea of the newborn, was first described as a syndrome by Mary Ellen Avery in 1966.1 Other names that have been applied to this problem are wet lung syndrome and respiratory distress syndrome Type II. It is a diagnosis of exclusion and is generally a benign, self-limiting condition of the term or near-term neonate lasting 24 to 48 hours and occasionally up to 72 hours. The most prominent findings are tachypnea with respiratory rates as high as 120 per minute, grunting, nasal flaring, minimal to no retractions, minimal cyanosis, and mild hypoxemia. The onset of clinical findings appears soon after birth or at birth. Both the clinical and x-ray findings resolve within 72 hours.

Noonan Syndrome Complicated by Primary Pulmonary Lymphangiectasia.

Abstract Noonan syndrome is a genetic disorder that has several features common to other conditions, making diagnosis a challenge. This column summarizes the case of a neonate with an atypical presentation of Noonan syndrome involving a fatal type of lymphangiectasia resulting in persistent pleural effusions. Radiographic features of this condition are presented along with the complexities of diagnosis and treatment.

Upping the ante again: clinical topics and the EBP process.

IF THE TITLE OF THIS EDITORIAL LOOKS FAMILIAR, THAT IS because it is the same title as the editorial in the May/June 2007 issue of Neonatal Network.® We would like to expand on the topic of Evidence-Based Practice (EBP) and how that might be reflected in the articles that we seek to publish in Neonatal Network:® The Journal of Neonatal Nursing.

Radiology Basics, Part IV: Cardiac Assessment

THE EVALUATION OF THE NEONATAL HEART ON CHEST x-ray film, although generally similar to the adult, is unique in many ways. The clinician must take into account the unique cardiovascular aspects of the fetal heart, the dramatic changes that occur at birth, and other aspects peculiar to neonatal physiology.