Newborn is Killed by Umbilical Catheter

Case Overview

This case takes place in North Carolina and involves a pregnant woman who presented to the hospital with preliminary signs of labor, at which point she was admitted for observation. She experienced vaginal bleeding for a significant amount of time, and eventually the decision was made to induce labor. The baby was successfully delivered, and an umbilical catheter was placed. After some time, it was discovered that the baby was bleeding from a perforation of one of his major internal organs made by the tip of the umbilical catheter. In spite of heroic efforts to revive the baby, he eventually succumbed to his wounds and died.

Questions to the Neonatology expert and their responses

How often do you place umbilical catheters in infants?

Umbilical catheters are a common means of arterial and venous access for very preterm infants. At least 50% of infants born at 28 weeks gestation undergo UVC +/- UAC placement shortly after birth - a number higher in those that are small for gestational age or requiring significant respiratory or blood pressure support.

What measures should be taken to prevent injury to internal organs when placing these devices?

While use of umbilical catheters are common in NICUs, they are not without complications. After careful sterile placement of the catheter, its accuracy of placement must be determined prior to use.

What monitoring is required to ensure good placement of an umbilical catheter?

Infants with umbilical catheters must be monitored closely and handled carefully, as migration of the catheter tip may occur. If there is any change in the infant's status, especially abdominal distension, then location of the catheter must be verified. If it is in the liver or an extraluminal location, then it needs emergent attention.

About the expert

This qualified expert is an Assistant Professor of Pediatrics at amogn the nation's top medical schools and has been on faculty for the Division on Neonatology since 2001. He is the director of the Intermediate Level Nurseries and assistant director of the Special Infant Care High Risk Follow-up Clinic at his current institution. He has cared for many infants with conditions similar to that descibed in the case and is very familiar with the standard of care in diagnosing and treating infants with in utero or perinatal hypoxic events. He is an expert in caring for these babies in the neonatal period, and also knows the standard of care in diagnosing in utero and perinatal hypoxic events, and prescribing therapeutic interventions when motor deficits present outside the newborn period.