Phrenic nerve damage in the tiny infant during vein cannulation for parenteral nutrition

An infant weighing 740 gm at birth underwent right internal jugular venous cannulation for the administration of parenteral nutrition at age 17 days. The roentgenogram obtained to assess catheter placement revealed a high right diaphragm for the first time in the course of the infant. The phrenic palsy was incurred during the cutdown in the neck of the tiny, then 650 gm, infant. Two similar patients are mentioned in the literature. The phrenic palsy appeared to delay improvement in the respiratory status of this infant. This patient illustrates the fact that phrenic nerve palsy is a potential complication of central line placement in the neck of a very low birthweight infant.