Bilateral pleural effusion complicating umbilical venous catheterization.

Area of Science:

• Neonatal Medicine
• Pediatric Cardiology
• Critical Care

Background:

• Umbilical venous catheters (UVCs) are crucial for neonatal intensive care but can lead to complications like pleural and pericardial effusions.
• Line migration is a common cause of UVC-associated effusions, necessitating careful monitoring.

Observation:

• A case of bilateral chylous pleural effusion was observed in a 28-week extremely low birth weight infant receiving total parenteral nutrition.
• Initial investigations, including chest X-ray and 2D echocardiogram, revealed bilateral chylous pleural effusions but indicated appropriate UVC tip positioning.

Findings:

• Complete resolution of the chylous pleural effusions was achieved after removal of the umbilical venous line and discontinuation of total parenteral nutrition.
• This suggests a potential link between the UVC and the development of chylous effusions, independent of apparent correct positioning.

Implications:

• Clinicians should maintain a high index of suspicion for UVC-related complications in neonates presenting with acute deterioration, particularly effusions.
• Apparent correct catheter position on imaging should not preclude consideration of catheter removal if clinical deterioration suggests a complication.
• Prompt removal of the central venous catheter may be crucial for managing effusions and improving outcomes in critically ill neonates.