Extract:
“A premature infant was delivered at 30 weeks with a birth weight of 1440 g. The infant required intubation at birth for respiratory distress syndrome. On the second day of life, a peripherally inserted central catheter (PICC) was placed via the left saphenous vein for administration of total parenteral nutrition (TPN). The tip of the catheter was thought to be in the lower inferior vena cava from the plain anteroposterior (AP) radiograph (figure 1) and TPN infusion was commenced. Ten days later, the infant developed multiple apneic episodes and became hypotonic. A lumbar puncture was performed as part of the septic workup. The cerebrospinal fluid (CSF) peculiarly appeared milky white (figure 2). Biochemical analysis of the CSF revealed a high concentration of triglycerides (31.74 mmol/L) and proteins (1.05 g/L), suggesting TPN solution in the CSF. Serum triglycerides were normal (0.57 mmol/L). Blood and CSF cultures were negative. The infant’s radiograph was reviewed again, realising the catheter was likely inadvertently placed in the left ascending lumbar vein instead. The infusion of TPN was terminated and the catheter removed, resulting in clinical improvement and resolution of the neurological symptoms. The infant had an uneventful recovery with no neurological sequelae.”
Reference:Chin L, Choo PPL, Ng DC. Parenteral nutrition solution in cerebrospinal fluid of a neonate: complication from a malpositioned central venous catheter. BMJ Case Rep. 2021 Nov 2;14(11):e246970. doi: 10.1136/bcr-2021-246970. PMID: 34728517.