title: Pericardial effusion and cardiac tamponade in neonates: sudden unexpected death associated with total parenteral nutrition via central venous catheterization.
abstract: BACKGROUND
  Total parenteral nutrition (TPN) via central venous catheter (CVC) is used routinely to provide adequate nutrition for neonates, especially those with very low birth weights (VLBWN). Pericardial effusion and cardiac tamponade (PCE/CT) is a potentially life-threatening CVC complication.
  
  
  METHODS
  This autopsy study presents the gross and histopathologic findings in 5 neonates receiving continuous TPN via CVCs, who suddenly and unexpectedly died from PCECT.
  
  
  RESULTS
  The study population included five neonates (age 4-29 days, 3 males, 2 females, 4 VLBWN neonates, 1 full-term neonate). Chemical analysis of the milky-white PCE fluid showed high triglyceride levels (717-777 mg/dL) consistent with intralipid. Right atrial microscopic examination with the four VLBWNs showed interstitial edema and dilated lymphatics (n=4), atrial thrombus (n=1), and focal fibrinous epicardial exudate (n=1). The full-term neonate RA revealed focal myocyte coagulative necrosis, acute organizing hemorrhage, focal collagen deposition, myocardial hypertrophy, and endocardial thickening.
  
  
  CONCLUSIONS
  Right atria in PCE/CT demonstrated marked interstitial edema and dilated fine vascular channels. Endocardial injury with permeation of hyperosmotic TPN fluid into the interstitium and egress into the pericardial sac is hypothesized as the etiology of PCE/CT. Recognition of PCE and impending CT in neonates with CVCs for TPN with expedient intervention may avoid sudden unexpected deaths.
authors.affiliation: Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Mikako
authors.initials: M
authors.lastname: Warren
authors.forename: Karen S
authors.initials: KS
authors.lastname: Thompson
authors.forename: Edwina J
authors.initials: EJ
authors.lastname: Popek
authors.forename: Hannes
authors.initials: H
authors.lastname: Vogel
authors.forename: John
authors.initials: J
authors.lastname: Hicks
mesh_terms: D001344:Autopsy; D002305:Cardiac Tamponade / Q000209:etiology / Q000473:pathology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D010490:Pericardial Effusion / Q000150:complications / Q000209:etiology*; D013398:Sudden Infant Death / Q000209:etiology*
keywords: cardiac tamponade; central venous catheter; intralipid; neonate; total parenteral nutrition