A successful interdisciplinary collaboration for the management of pneumoperitoneum and pericardial effusion in a premature newborn

Abstract

Objectives. Percutaneously central catheters are typically used in neonatal intensive care units (NICU) to provide parenteral nutrition and drug therapy administration. Their use is associated with specific complications: occlusions, infections, thrombosis, rupture, and migration, including rare life-threatening conditions such as pericardial effusion and cardiac tamponade. Material and methods. We present the case of a patient hospitalized in the Neonatology Department of “Sf. Andrei” County Clinical Emergency Hospital of Constanta, diagnosed with cardiac tamponade at 18 days of life. Outcomes. Premature male newborn, gestational age (GA) of 33 weeks, birth weight (BW) 2380 g, Apgar score 5/7, issuing from pregnancy without prenatal care, admitted in NICU with Continuous Positive Airway Pressure (CPAP) respiratory support. He required intensive care during the neonatal period and presented with sudden cardiac instability 18 days after the insertion of a peripherally inserted central catheter (PIC-Line). The echocardiography demonstrated severe pericardial effusion with evidence of cardiac tamponade. Successful urgent subxiphoid pericardiocentesis was performed. Totally 20 ml of fluid was collected, consistent with the composition of the hyperosmolar solution infused. Conclusions. Despite the fact that it is a rare complication, cardiac tamponade should be considered in any newborn with a PIC-Line who presents with sudden suggestive deterioration (cardiorespiratory instability, bradycardia, cyanosis and metabolic acidosis), which does not respond to resuscitation maneuvers, when lines are considered to be placed correctly. Implementing a modern algorithm, who is easy to learn and quick to perform, with the help of ultrasonography, represents the key of success for detecting urgent neonatal complications leading to sudden deterioration.