Neonatal segmental myoclonus associated with hyperglycorrhachia

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.