Double-catheter technique for the proper insertion of umbilical venous catheters in newborns

To document the usefulness and safety of inserting a second umbilical venous catheter in ill neonates, while a previously misplaced first catheter was still in its place. Subjects and Methods:The case series involved 25 newborn babies who were admitted to the Neonatal Intensive Care Unit, Maternity Hospital, Kuwait, over a 3-year period from 1999 to 2002. The umbilical venous catheter of the babies was misplaced and diverted to the liver, necessitating insertion of a second catheter while the previous one was still in place. The characteristics of the babies and possible catheter-related complications were recorded. Results:Of the 25 babies, 19 had the second catheter properly placed in the right atrium, while in the remaining 6 neonates, the catheter was still misplaced. Misplacement occurred mostly in full-term babies or the catheter was inserted at a later stage. No life-threatening complication was observed during the procedure. Conclusion:Insertion of a second umbilical venous catheter with the misplaced first catheter in situ is a useful and safe procedure

Perinatally acquired tuberculosis in a neonate

To report a case of perinatal tuberculosis that appeared on the 21th day of life of an infant born to a mother with latent tuberculosis. Clinical Presentation and Intervention: A preterm male infant was born by spontaneous vertex delivery at 33 weeks gestational age to a 33-year-old primiparous Philippine woman. The infant was well until the 21st day of life when he developed recurrent episodes of cyanosis and bradycardia. A chest radiograph showed infiltrates which were thought to be bacterial in origin. Blood, urine, and cerebrospinal fluid cultures were normal. Tracheal aspirate revealed acid-fast bacilli by Ziehl-Neelsen stain, later confirmed to be Mycobacterium tuberculosis by culture in Lowenstein-Jensen medium. The mother was later diagnosed as a case of tuberculosis with symptoms, signs and radiologic manifestation of hilar lymphadenopathy with mild pleural effusion and positive tuberculin skin test. Both infant and mother were treated with intravenous isoniazid, intravenous rifampicin, oral pyrazinamide, and intravenous pyridoxine. Both recovered. A preterm male infant perinatally acquired tuberculosis, most likely by inhalation of the bacteria during delivery. Both infant and mother responded well to antituberculous treatment