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Finding alternative sites for intraosseous infusions in newborns
Frank Eifinger1, Martin Scaal2, Lukas Wehrle1
1Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany.
Resuscitation
|April 16, 2021
Summary
This study explored alternative intraosseous (IO) access sites in stillborns, finding the proximal humeral head and distal femoral end suitable for IO puncture. These sites offer potential for improved resuscitation in neonates.
Area of Science:
- Pediatric Resuscitation
- Anatomy
- Medical Imaging
Background:
- Intraosseous (IO) access is a critical resuscitation route.
- The proximal tibia is the conventionally recommended IO puncture site.
- Alternative sites are needed, particularly for preterm and term neonates.
Purpose of the Study:
- To identify and evaluate alternative intraosseous (IO) puncture sites in preterm and term stillborns.
- To compare the anatomical suitability of the proximal humerus, distal femur, and proximal tibia for IO access.
Main Methods:
- Spectral-CT analysis of 20 stillborns (mean gestational age 29.2 weeks).
- Measurement of bone diameters and circumferences at proximal humerus, distal femur, proximal tibia, and tibial diaphysis.
- Contrast medium injection to assess vascular drainage from potential IO sites.
Main Results:
- Term neonates showed comparable diameters for proximal humeral head (12.1 mm), distal femur (11.9 mm), and proximal tibia (12.0 mm).
- Significant age-related growth in diameter and cross-sectional size was observed in preterm groups.
- Contrast medium injected into the distal femur and proximal humerus rapidly drained into the central venous system.
Conclusions:
- The proximal humeral head and distal femoral end are viable alternative IO access sites in neonates.
- These findings may expand the options for IO puncture during resuscitation in infants.
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