Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade.

Fatal cardiac tamponade is a well recognised complication of the use of central venous catheters in neonatal patients. There is controversy over optimum catheter tip position to balance catheter performance against risk of adverse events. We report a series of five cases of tamponade occurring in one neonatal unit over a 4-year period, related to catheter tip placement in the right atrium. Right atrial catheter angulation, curvature or looping (CA) was present in all five cases on plain radiograph. It was frequently seen in other patients over the same period. Review of the literature indicates that CA was present in 6 of the 11 previous cases where the presence or absence of CA can be determined. Where right atrial catheter tip placement is accepted, clinicians should be aware of this characteristic catheter configuration, which is a major risk factor for cardiac tamponade. We recommend that catheter tips should not be placed in the right atrium to avoid risk of tamponade.

Pattern of expression of c-erbB-2 oncoprotein in human fetuses.

The pattern of expression of the c-erbB-2 oncoprotein was investigated in whole mount preparations of 11 human fetuses by immunocytochemistry using two polyclonal antibodies, 20N and 21N. c-erbB-2 was widely expressed within all three germ layers. Expression remained relatively constant in epithelial, mesodermal and extraembryonic tissues, but varied over time during the development of the fetal skeleton. Western blotting failed to detect c-erbB-2 in normal fetal tissues but did confirm expression in a microvillous membrane preparation of placenta. c-erbB-2 expression is widespread in the human fetus and occurs at an earlier stage than epidermal growth factor receptor.

The influence of dose-delivery time interval on neonatal plasma pethidine levels.

Plasma pethidine levels were determined by RIA during the first 24h of life in 126 neonates whose mothers had received a single intramuscular dose of 100-150 mg pethidine HCl 0.25 to 19.5 h before delivery. The mean (geometric) maternal and cord venous plasma pethidine concentration and the neonatal capillary plasma levels at 0.5, 1.5 and 12-24 h expressed per unit dose were 125, 98, 71, 59 and 23 ng/ml per mg/kg respectively. The mean (+/- S.E.M.) cord: maternal plasma concentration ratio was 0.741 +/- 0.036 (n = 40). The ratio was significantly correlated with the dose-delivery interval, r = 0.42, p less than 0.01. The pethidine concentration in cord and in neonatal capillary plasma was significantly correlated to the weight related dose, r = 0.25 to 0.48, p less than 0.01. Cord venous levels of pethidine rose rapidly after drug administration but neonatal capillary levels increased slowly to reach peak levels at 2 to 5 h before declining over the next 15 to 18 h. The maternal plasma pethidine half-life, 5.59 h was considerably shorter than that observed in the newborn, 15.94 h.