Phrenic Nerve Damage in the Tiny Infant During Vein Cannulation for Parenteral Nutrition

Abstract

An infant weighing 740 gm at birth underwent right internal jugular venous cannulation for the administration of parenteral nutrition at age 17 days. The roentgenogram obtained to assess catheter placement revealed a high right diaphragm for the first time in the course of the infant. The phrenic palsy was incurred during the cutdown in the neck of the tiny, then 650 gm, infant. Two similar patients are mentioned in the literature. The phrenic palsy appeared to delay improvement in the respiratory status of this infant. This patient illustrates the fact that phrenic nerve palsy is a potential complication of central line placement in the neck of a very low birthweight infant.

Diaphragmatic paralysis in young children: A literature review

“…Finally, other miscellaneous traumatic causes have been reported, such as deep‐chest tube insertion and venous subclavian or jugular catheter insertion . DP related to diffusion of parenteral nutrition around the phrenic nerves through a peripherally inserted central catheter line has also been reported …”

Diaphragmatic paralysis in extremely low birthweight neonates: Is waiting for spontaneous recovery justified?

“…[7][8][9][10][11][12][13] In general, infants do not tolerate diaphragmatic paralysis due to their highly compliant rib cage that does not support the paralysed hemidiaphragm and the relatively low aerobic capacity of their diaphragm. [14][15][16] The compromise in respiratory function is more pronounced in ELBW neonates, a subgroup of high-risk neonates with a prolonged need for ventilatory support and an increased risk of CLD. 17,18 Diaphragmatic paralysis usually presents as respiratory distress or difficulty in weaning from the ventilator.…”