Vol 44 # 2 June 2012 - Kma.org.kw

141
KUWAIT MEDICAL JOURNAL
June 2012
Case Report
Neonatal Cardiac Tamponade: What is the Cause?
Mervat F Khalil 1 , Aditya Raina 1 , Majeda S Hammoud 2
1
Department of Neonatology, Al-Sabah Maternity Hospital, Kuwait
2
Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait
ABSTRACT
Kuwait Medical Journal 2012; 44 (2): 141 - 142
We present one case of neonatal cardiac tamponade
due to percutaneous jugular venous catheterization,
a rare and potentially fatal complication. In neonates
with central venous catheters, the incidence of
pericardial effusion (PCE) with tamponade is 0.5 - 2%.
Perforation usually has a delayed course and results
from endothelial injury, caused by the fluids, which
leads to necrosis and thrombosis. This fluid then
diffuses transmurally across the myocardium into the
pericardium. Even if the catheter tip is placed properly
and checked immediately after placement, it can
migrate, an incidence which implies that the position
of the catheter be checked at least twice a week after
insertion.
KEY WORDS: myocardium, newborn, ventilation
INTRODUCTION
Central venous catheterization is frequently
used in infants in the neonatal intensive care setting
and is associated with several complications,
including occlusion, infection, thrombosis, breakage,
displacement and migration of the catheter plus
perforation of the vessel wall [1] . We present a case of
neonatal cardiac tamponade due to percutaneous
jugular venous catheterization, a rare and potentially
fatal complication.
CASE REPORT
A 27-week preterm male baby born by normal
vaginal delivery with a birth weight of 1.080 kg was
admitted immediately and ventilated after birth in
Al-Sabah Maternity NICU with a diagnosis of hyaline
membrane disease.
The baby received two doses of surfactant and was
on high frequency oscillatory ventilation since 10 hrs
of age. He improved gradually and was extubated
after eight days. Feeds were started and gradually
increased while the baby was shifted to special care
unit to continue his care.
At 51 days of age, a percutaneous central catheter
was electively inserted through the left external
jugular vein and placed at the root of the superior
vena cava. The position was confirmed by chest X–ray.
Intravenous fluids were started through this route. The
baby remained stable for six days initially and then he
had sudden desaturation and bradycardia for which
he was shifted back to the NICU, intubated and was
put on mechanical ventilation.
His BP was 76/49 mmHg, MAP 35 mmHg and HR
was 157 bpm. A chest X-ray taken at this stage showed
cardiomegaly and there was migration of the catheter
tip from superior vena cava to the right ventricle.
Echocardiography (ECHO) confirmed significant
pericardial effusion with tamponade. Intravenous
fluids were immediately stopped and the percutaneous
jugular catheter was removed. The pericardial effusion
was drained immediately by ECHO guided subxiphoid
pericardiocentesis. Approximately 32 ml of clear fluid
was aspirated from the sac. Biochemical analysis of
this fluid proved it to be the infusate. ECHO done 12
hrs later, showed complete clearing of the fluid.
The baby improved after this and was extubated
and later discharged in a satisfactory condition.
DISCUSSION
Pericardial effusion (PCE) with tamponade is a rare
complication of central venous catheters associated
with high mortality [1] . In neonates with central venous
catheters, the incidence of PCE with tamponade is 0.5
- 2%, and mortality varies from 45 to 67% [2] .
A study by Beardsall et al estimated the frequency
of PCE with cardiac tamponade occurring with
percutaneous long lines to be 1.8 / 1000 lines [3] . High
fatality is due to its sudden onset and fast deterioration.
Address correspondence to:
Dr. Mervat F. Khalil, MRCPch (UK), Dept. of Neonatology, Al Sabah Maternity Hospital Kuwait. Tel: 25319486, 97125527 (M), Fax: 25338940
E-mail: asiyatasneem57@yahoo.com