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Neonatal segmental myoclonus associated with hyperglycorrhachia
1Division of Neonatal-Perinatal Medicine, Eastern Virginia Medical School, Norfolk, USA.
Insights
Segmental myoclonus in infants can stem from various conditions. This case highlights a rare cause: a misplaced femoral catheter leading to extreme hyperglycemia, emphasizing the need for proper catheter placement verification.
Area of Science:
- Neonatal neurology
- Pediatric critical care
- Medical device complications
Background:
- Segmental myoclonus is a rare infantile movement disorder with diverse etiologies including sepsis and spinal cord abnormalities.
- Parenteral nutrition is a common supportive therapy in premature infants.
Observation:
- A premature infant developed segmental myoclonus and severe hyperglycemia.
- This was linked to a femoral percutaneous indwelling central catheter that had migrated into a paravertebral vein.
- The catheter was used for parenteral nutrition administration.
Findings:
- Catheter malpositioning can lead to unexpected and severe complications.
- Extreme hyperglycemia in neonates can manifest with neurological symptoms like myoclonus.
- Paravertebral venous migration of femoral catheters is a potential, albeit rare, complication.
Implications:
- Accurate catheter placement is critical for safe parenteral nutrition delivery in neonates.
- Consider catheter migration in the differential diagnosis of unexplained neurological signs in infants receiving central venous access.
- Implementing routine lateral abdominal radiography can improve detection of malpositioned femoral catheters.
Abstract:
Segmental or spinal myoclonus is an uncommon involuntary movement in infancy which has been attributed to sepsis, degenerative and developmental diseases of the spinal cord, birth trauma, and sclerosing panencephalitis. A premature infant presenting with segmental myoclonus associated with extreme hyperglycorrhachia secondary to the administration of parenteral nutrition through a femoral percutaneous indwelling central catheter that had inadvertently migrated into a paravertebral vein is reported. We recommend a lateral abdominal radiograph in addition to the usual anteroposterior view to confirm the correct placement of femoral catheters.