Legal Briefs: Devastating Consequences From Prolonged Use of an Umbilical Arterial Catheter

Abstract

A 960-g, 26-3/7 weeks’ gestation male twin B was delivered by normal vaginal spontaneous delivery in the breech position to 31-year-old, healthy, gravida 3 para 1 mother whose pregnancy was complicated by preterm labor and diamniotic dichorionic twins. The mother received antibiotics, a partial course of betamethasone, and magnesium sulfate for tocolysis. At delivery, the infant had a heart rate (HR) less than 100 beats per minute, no respiratory effort, and was blue. The infant was intubated and required resuscitation, including chest compressions for 15 seconds, and 2 doses of epinephrine via an endotracheal tube (ETT). Apgar scores were 2 at 1 minute, 4 at 5 minutes, and 7 at 10 minutes. The infant was then admitted to the NICU, where an umbilical venous catheter (UVC) and an umbilical arterial catheter (UAC) were placed. The UVC was placed in the right atrium, where it remained until its removal several days later, and his UAC was placed appropriately at the seventh thoracic vertebrae and removed on day 13. The infant’s vital signs and blood pressure were normal. He had respiratory distress syndrome, for which he was given 3 doses of surfactant. Initially, the infant required 100% oxygen, but after several hours, the inspired oxygen was weaned to 30%, and the ventilator settings were low. His initial complete blood cell count revealed a white blood cell count (WBC) of 3.1 × 103/uL, a platelet count of 185 × 103/uL, and a hematocrit reading of 51% (0.51). The infant was given ampicillin and gentamicin after blood culture results were obtained, and he was started on low-dose indomethacin for intraventricular hemorrhage prophylaxis. On day 1, the fraction of inspired oxygen (Fio2) and ventilatory settings were low. The blood gas values were normal, with some permissive hypercarbia in the …