Umbilical artery catherisation is useful in managing sick newborns which help in frequent samplings for arterial blood gases, monitoring arterial blood pressures.Although UAC catherisation is considered generally safe, various complications like Central Line Associated Blood Stream Infection (CLABSI), arrhythmias, Disseminated Intravascular Coagulation (DIC) and vessel perforation have been noticed in newborns. Here we describe an accidental UAC fracture in our NICU which was successfully retrieved (endovascular) without any complication at one month follow-up.

About the case:

A seven day old female, early term neonate of 37weeks gestational age with birth weight of 2836 gms, born through LSCS (Lower segment Caserian section) developed respiratory distress at 2 hours of life. Chest x-ray showed bilateral pneumonia which required intravenous antibiotics for seven days. Neonate developed persistent pulmonary hypertension (PPHN) at 28 hours of life which was confirmed by functional 2D ECHO. Umbilical catheters (UAC of 3.5 French and UVC of 5 French) were inserted on day two of life as the neonate was critically ill and required management for PPHN. On day six of life, UAC was accidentally removed and was broken at 15cms mark. The remaining catheter measuring about 15 cms was inside the umbilical artery which was confirmed by CT angiography (distal tip in thoracic descending aorta at D6- D7 level and proximal tip in right umbilical artery approximately 2 cms beneath the umbilical stump). Catheter was transfixed in the deep umbilical stump through an infra umbilical incision. But the catheter slipped into right common iliac artery which was then transfixed and endovascular retrieval of the whole 15 cms UAC along with the tip was done. Thus retrieval of the lodged catheter. There was minimal blood loss (5ml) during the procedure. Neonate was observed for 2 weeks and successfully discharged from NICU. She was followed up for a month post discharge and had no complications.

Namita Sahu is a distinguished pediatrician and neonatologist with extensive expertise in clinical care, research, and healthcare leadership. She completed her MD in Pediatrics from Sambalpur University, Odisha, at the age of 32, followed by a DM in Neonatology from Seth G.S. Medical College & KEM Hospital, Maharashtra University of Health Sciences, Mumbai, in 2021. She further strengthened her super-specialty training by completing her DrNB in Neonatology in 2022. She is currently serving as the Head of the Department of Pediatrics and Neonatology at JP Hospital, Odisha, India, and also holds the position of Medical Superintendent at the institution. Her clinical and academic interests include neonatal intensive care, pediatric critical care, and quality improvement initiatives across the NICU, PICU, and pediatric departments. She has authored numerous national and international publications, contributed chapters to two neonatology textbooks, and serves as a reviewer for articles published in the Journal of Pediatrics by the American Academy of Pediatrics (AAP). She has also been a faculty member for the National Neonatal Refresher Course and is an internationally certified lactation consultant. An avid researcher and dedicated mentor, she is actively involved in mentoring pediatric and neonatal units at district and community levels through both telemedicine and hands-on training, with a strong commitment to strengthening neonatal and child health services.