title: Hemidiaphragmatic paralysis in preterm neonates: a rare complication of peripherally inserted central catheter extravasation.
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.
authors.affiliation: Réanimation Néonatale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire Nord, Marseille 13015, France.
authors.forename: Barthelemy
authors.initials: B
authors.lastname: Tosello
authors.forename: Fabrice
authors.initials: F
authors.lastname: Michel
authors.forename: Thierry
authors.initials: T
authors.lastname: Merrot
authors.forename: Kathia
authors.initials: K
authors.lastname: Chaumoître
authors.forename: Sophie
authors.initials: S
authors.lastname: Hassid
authors.forename: Pierre
authors.initials: P
authors.lastname: Lagier
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000150:complications; D055499:Catheter-Related Infections / Q000150:complications; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D004058:Diffusion; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D006325:Heart Atria; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009994:Osmolar Concentration; D057947:Parenteral Nutrition Solutions / Q000008:administration & dosage / Q000009:adverse effects*; D010791:Phrenic Nerve / Q000187:drug effects / Q000293:injuries*; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012772:Shock, Septic / Q000150:complications; D013203:Staphylococcal Infections / Q000150:complications; D013212:Staphylococcus epidermidis; D013908:Thoracotomy; D014463:Ultrasonography; D014683:Vena Cava, Superior
chemical_list: D003287:Contrast Media; D057947:Parenteral Nutrition Solutions