[Use of the intraosseous route in a premature infant]

The intraosseous route (IOR) is a rehabilitated vascular access in emergency situations. Its indications and duration are defined, although the age limit at which it is usable is not clearly established.

A 34-week-old preterm neonate, without infection, receiving gastric gavage, developed, at 8 days of life, a severe septic shock requiring ventilatory support and emergency volume expansion via a subclavian catheter. During the chest X-ray to check its position, the catheter was unfortunately pulled out. The child presented an acute desaturation with bradycardia, requiring bag ventilation and endotracheal epinephrine. The umbilical vein being unusable, an intraosseous access (20 G, distal hole, Cook) was performed at the upper tibial level to continue resuscitation and left in place for 14 hours to infuse antibiotics, inotropic support, blood products and colloids. Blood cultures grew Klebsiella pneumoniae. After a severe initial phase, course was favorable with normal examination at 3 years without complication of the IOR.

To our knowledge, it is the youngest child in whom IOR was performed. For neonates and especially preterms, the site of puncture is just below the tibial superior tuberosity, otherwise there is a risk of fracture of the diaphysis. This risk justifies the control of the IOR by X-ray. The place of the IOR among emergency vascular accesses in neonates, seems to us to be reserved to situations when umbilical vein is unusable.

Although no study compared IOR to superior longitudinal sinus access, we suggest to reserve the sinus access only when IOR has failed, because of its potential cerebral complications.