title: Low cardiac output secondary to a malpositioned umbilical venous catheter: value of targeted neonatal echocardiography.
abstract: Systemic hypotension is common in very low birthweight preterm infants but the nature of the precipitating cause may be unclear. Targeted neonatal echocardiography (TnEcho) is being increasingly used to support hemodynamic decisions in the neonatal intensive care unit (NICU), including identifying impairments in the transitional circulation of preterm infants, providing timely re-evaluation after institution of therapies and evaluating the placement of indwelling catheters. We present a case of a preterm infant with systemic hypotension and low cardiac output secondary to a large transatrial shunt induced by a malpositioned umbilical venous catheter. Repositioning of the line led to resolution of the hemodynamic disturbance and clinical instability, highlighting the utility of TnEcho in the NICU.
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Dany E
authors.initials: DE
authors.lastname: Weisz
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Wei Bing
authors.initials: WB
authors.lastname: Poon
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: James
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada ; Physiology and Experimental Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada ; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
keywords: atrial septal defect; low cardiac output; targeted neonatal echocardiography; umbilical venous catheter