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Resolution of Multiple Aortic Aneurysms in a Neonate

Journal of Perinatology volume 25, pages 60–62 (2005)Cite this article

The use of umbilical artery catheters (UAC) is common in the management of critically ill neonates, but may be associated with a variety of complications including infection, thrombosis, aortic dissection, hypoglycemia, umbilical artery rupture, and paraplegia.1 Aortic aneurysms, with reported high morbidity and mortality, have also been reported in association with UAC's.2, 3, 4 We report a case of a 24-week infant who developed multiple aortic aneurysms associated with use of an UAC complicated by a Staphylococcus aureus infection with subsequent spontaneous resolution of aneurysms after 5 months.

A 665-g-infant male was born to a 22-year-old gravida 1, para 0 mother at 24 weeks gestation by emergent Cesarean section secondary to placental abruption. Maternal pregnancy was complicated by 2 weeks of preterm labor for which she received indomethacin tocolysis, a full course of dexamethasone, as well as antibiotic prophylaxis. Upon delivery, the infant was noted to have severe respiratory depression requiring endotracheal tube intubation, surfacant administration, and mechanical ventilation. An umbilical vein catheter was placed, the tip of which was in the proximal inferior vena cava at the level of T9. A UAC was also placed, the tip of which was in the thoracic aorta at the level of T7–8. Ampicillin and gentamicin antibiotics were empirically started for sepsis and were stopped on day of life (DOL) 7, after initial blood culture was negative. The infant's course was initially complicated by hypotension requiring dopamine, dobutamine, epinephrine, and hydrocortisone (two doses of 1 mg/kg/dose) with pressor support weaned off by DOL 8. The infant developed pulmonary interstitial emphysema with bilateral pneumothoraces requiring chest tube placement and had a patent ductus arteriosus that was closed with indomethcin treatment. On DOL 25, a routine complete blood count test showed an elevated white blood cell count, with subsequent bandemia and thrombocytopenia. The infant had blood and cerebral spinal fluid cultures drawn, which were positive for Staphylococcus aureus. The infant's UAC was pulled and the tip sent for culture, which also grew S aureus that was methicillin sensitive. Despite treatment with oxacillin, gentamicin, and rifampin, his clinical course continued to deteriorate with persistent thrombocytopenia, hypotension, and a worsening respiratory status requiring increased setting with high-frequency oscillatory ventilation.

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Authors and Affiliations

  1. Department of Pediatrics, Wilford Hall Medical Center, San Antonio, TX, USA

    Ryan M McAdams MD

  2. Department of Pediatric Radiology, Wilford Hall Medical Center, San Antonio, TX, USA

    Randy R Richardson MD

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  1. Ryan M McAdams MD
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  2. Randy R Richardson MD
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The opinions expressed in this paper are solely those of the authors and do not represent the views of the United States Air Force, Department of Defense, or the United States Government.

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McAdams, R., Richardson, R. Resolution of Multiple Aortic Aneurysms in a Neonate. J Perinatol 25, 60–62 (2005). https://doi.org/10.1038/sj.jp.7211197

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