Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters

Background. A preterm infant was found to have total parenteral nutrition ( TPN) ascites after infusion through a low umbilical vein catheter (UVC). Objective. To evaluate the clinical and imaging findings of neonates with T PN ascites after infusion through UVCs. Materials and methods. Eight patients with TPN ascites were identified over three years. Charts were abstracted for clinical data. Plain-film, ultraso und (US), and contrast studies through the UVCs were examined to determine UVC placement, presence of liver injury, and confirmation of intraperitonea l extravasation from the UVC. Results. All eight patients with TPN ascites presented with hypotension and abdominal distension. All had UVCs overlying the liver on plain film. Cath eters were in place a mean of 8.9 days prior to TPN extravasation. US in fo ur patients showed hepatic parenchymal damage around the UVC tip. Contrast studies in six patients showed intraperitoneal spill. Conclusion. While low UVC placement may sometimes be clinically unavoidable , TPN administered through abnormally positioned UVCs is not without risk.