Cardiac tamponade and pericardial effusion due to venous umbilical catheterization.
OBJECTIVE
We present three cases of neonatal cardiac tamponade due to umbilical venous catheterization, a rare, but potentially fatal complication.


METHODS
Timely diagnosis was made by echocardiography, and an urgent pericardiocentesis revealed TPN fluid. Perforation of the cardial wall was proven by contrast X-ray showing contrast diffusing into the pericardial space.


CONCLUSIONS
Most frequently, perforation has a delayed course and results from endothelial injury, caused by the hyperosmolar fluids, leading to transmural necrosis and thrombosis. Subsequently, the fluid diffuses transmurally across the myocardium into the pericardium. As migration of the catheter tip can occur, we suggest that its position should be checked immediately after insertion and twice a week thereafter.


CONCLUSIONS
Pericardial effusion and cardiac tamponade should be considered in any infant with a central venous line who develops a rapid, unexplained clinical deterioration. Timely diagnosis and drainage has been proven to be life-saving.
Traen
Marijke
M
Department of Paediatrics, Division of Neonatology, Antwerp University Hospital, Edegem, Belgium. marijketraen@uza.be
Schepens
Elisabeth
E
Laroche
Sabine
S
van Overmeire
Bart
B
D002305:Cardiac Tamponade / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010490:Pericardial Effusion / Q000150:complications / Q000209:etiology*; D014463:Ultrasonography; D014471:Umbilical Veins