BMJ Case Rep

. 2024 Feb 21;17(2):e257120.

 doi: 10.1136/bcr-2023-257120. https://pubmed.ncbi.nlm.nih.gov/38383126/

TPN ascites: an uncommon cause for acute deterioration on mechanical ventilation in a neonate with congenital diaphragmatic hernia

Richie Dalai ¹, Umang Bhardwaj ¹, Anu Thukral ²

Affiliations expand

• PMID: 38383126
• PMCID: PMC10882441 (available on 2026-02-21)
• DOI: 10.1136/bcr-2023-257120

Abstract

On ventilation since birth, a term neonate with an antenatally detected left-sided congenital diaphragmatic hernia (CDH) had a sudden worsening in respiratory parameters on day 5 of life. Tube displacement, obstruction, pneumothorax and equipment failure were all ruled out. The examination revealed decreased air entry on the left side and mild abdominal fullness. The chest and abdomen radiographs revealed the absence of bowel gas with a complete whiteout of the abdominal cavity. Since birth, the neonate had received parenteral nutrition via the umbilical venous line. Keeping a possibility of ascites and pleural effusion, an abdominal sonogram was performed, timely glove drain insertion was ensured, and umbilical lines were removed. The neonate improved dramatically and underwent CDH patch repair. Given the likely distorted vascular anatomy, this case underscores the need to re-examine the umbilical venous line insertion practice on the first day in CDH neonates.

Keywords: neonatal health; neonatal intensive care.

© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.