A Term Neonate with a Malpositioned Umbilical Artery Catheter Tip

Abstract

A term neonate with respiratory distress receiving endotracheal mechanical ventilation undergoes placement of umbilical venous and arterial catheters. ### Prenatal and Birth Histories ### Presentation The infant was admitted to the community hospital NICU. Endotracheal intubation was performed at 2 hours of age for increasing oxygen requirements and respiratory failure. Conventional mechanical ventilation was initiated with a fraction of inspired oxygen of 1.0. Chest radiography suggested meconium aspiration syndrome. Exogenous surfactant was administered and umbilical vein catheter (UVC) was placed. On radiography, the UVC tip was visualized in the liver and the catheter readjusted to a low-lying position and secured at 5 cm. The umbilical artery catheter (UAC) placement was unsuccessful. Blood culture specimen was obtained and treatment with ampicillin and gentamicin initiated. Persistent pulmonary hypertension of the newborn was suspected based on a 10% difference in pre- and postductal oxygen saturation; at 3 hours of age, inhaled nitric oxide (iNO) of 20 parts per million (ppm) was initiated for an oxygen index of 18 determined on a radial arterial blood gas. The infant was transferred to a level IV NICU for further evaluation and consideration of extracorporeal membrane oxygenation. Upon arrival at the level IV NICU, the neonate was placed on high-frequency oscillatory ventilation …