Neonatal necrotizing enterocolitis caused by umbilical arterial catheter-associated abdominal aortic embolism: A case report

Table 1 Main treatment and handling process during the patient’s hospitalization

Date	Events	Auxiliary examination	Handling	Treatment	Feeding
May 9	Umbilical artery catheter (UAC) and umbilical venous catheter (UVC) placement	(1) Chest X-ray showed that the tip positions of the UAC/UVC were in the 6th-7th thoracic vertebrae (Figure 1); and (2) Routine blood examination: Hemoglobin (HGB), 203 g/L; hematocrit (HCT), 59.4%; C-reactive protein (CRP), 2.1 mg/L	(1) Routine daily tubing maintenance; (2) Tube flushed and sealed with 0.5 IU/mL heparin solution q6h; and (3) The UAC was used for continuous invasive arterial blood pressure monitoring and continuous infusion of 0.5 IU/mL heparin solution; the UVC was used for intravenous medication and parenteral nutrition administration	Nasal continuous positive airway pressure, cefoperazone sodium/sulbactam sodium, ampicillin, caffeine citrate, vitamin K1	Completely hydrolyzed protein formula, 0.5 mL q12h; tube feeding
May 15	Invasive arterial blood pressure monitoring was stopped according to the doctor’s plan, and the UAC was maintained for blood sampling		(1) Routine daily tubing maintenance; and (2) Tube flushed and sealed with 0.5 IU/mL heparin solution q6h	Nasal continuous positive airway pressure, cefoperazone sodium/sulbactam sodium, ampicillin, caffeine citrate, vitamin K1	Completely hydrolyzed protein formula, 0.5 mL q8h; tube feeding
May 18	The UAC and UVC were removed, and a peripherally inserted central catheter (PICC) was inserted	(1) Chest X-ray showed that the tip position of the PICC was at the upper edge of the 6th thoracic vertebra (cannulation through an upper limb); and (2) Routine blood examination: HGB, 150 g/L; HCT, 43.9%; CRP, 2.9 mg/L	(1) Routine daily tubing maintenance; and (2) Tube flushed and sealed with 1 IU/mL heparin solution q6h	Nasal continuous positive airway pressure, cefoperazone sodium/sulbactam sodium, ampicillin, caffeine citrate, vitamin K1	Completely hydrolyzed protein formula, 0.5 mL q6h; tube feeding
May 19	Significant abdominal distension, visible bowel pattern, weakened bowel sounds		Feeding was paused once	Nasal continuous positive airway pressure, cefoperazone sodium/sulbactam sodium, ampicillin, caffeine citrate, vitamin K1	Feeding was paused once
May 20	Poor response, an elevated heart rate range of 175-180/min (normal temperature), abdominal distension but soft to palpation, normal bowel sounds; a total of 24 g of currant jelly stool	(1) Chest X-ray: the tip position of the PICC was at the 7th-8th thoracic vertebrae; (2) Abdominal X-ray: the small intestine showed inflation, but no obvious dilatation of the intestinal lumen or effusion was noted (Figure 2); (3) Color Doppler-mode ultrasound showed a partial thrombosis of the abdominal aorta (2 cm × 0.3 cm) and abdominal effusion; (4) Routine blood examination: HGB, 94 g/L; HCT, 25.8%; CRP, 15.6 mg/L; PCT, 0.74 ng/mL; and (5) Coagulation function: prothrombin time (PT) 14.6 s; activated partial thromboplastin time (APTT) 55.9 s	(1) A crossmatch test was performed immediately; active blood transfusion and plasma transfusion; (2) The position of the PICC was adjusted, and the heart rate decreased to 160/min; a recheck showed that the tip position of the PICC was at the 6th thoracic vertebra; (3) Surgery consultation; and (4) Fasting, gastrointestinal decompression	(1) Cefoperazone sodium/sulbactam sodium was stopped; (2) Meropenem and fluconazole were added; (3) Low-molecular-weight heparin sodium q12h anticoagulant therapy was added; and (4) Other treatments were the same as before	Fasting; gastrointestinal decompression
May 21	A total of 15 g of dark-red currant jelly stool	(1) Abdominal X-ray showed that the range of intestinal inflation increased over previous measurements (Figure 3); and (2) Routine blood examination: HGB, 113 g/L; HCT, 31.7%	(1) Reexamination of routine blood parameters and abdominal X-ray; and (2) Blood transfusion	Additional diagnosis: abdominal aortic thrombosis, neonatal necrotizing enterocolitis (stage IIA)	Fasting; gastrointestinal decompression
May 22		Anti-Xa activity: 0.4 IU/mL (on the lower side)	The dose of low- molecular-weight heparin sodium was increased	Additional diagnosis: abdominal aortic thrombosis, neonatal necrotizing enterocolitis (stage IIA)	Fasting; gastrointestinal decompression
May 25	Slight abdominal distention, audible bowel sounds, and a small amount of brown stool was produced after an enema	Blood routine examination: HGB, 106 g/L; HCT, 27.5%; CRP, 0.7 mg/L	A crossmatch test was performed immediately; transfusion	Meropenem was replaced with piperacillin	Fasting; gastrointestinal decompression
May 26	Dark green stool	B-ultrasound: Partial thrombosis of the abdominal aorta (0.6 cm × 0.2 cm, 0.3 cm × 0.2 cm)		Meropenem was replaced with piperacillin	Fasting; gastrointestinal decompression
May 31	Dark green stool			Gastrointestinal decompression was stopped; feeding started	Completely hydrolyzed protein formula, 0.5 mL q6h; tube feeding
June 1	Soft abdomen, normal bowel sounds	Blood routine examination: HGB, 83 g/l; B-ultrasound: partial thrombosis of the abdominal aorta (0.5 cm × 0.2 cm, 0.2 cm × 0.1 cm)	Transfusion	Low-molecular-weight heparin sodium was stopped; Piperacillin was stopped; The PICC was removed	The amount of milk was increased appropriately
July 14		B-ultrasound: partial thrombosis of the abdominal aorta (0.4 cm × 0.2 cm, 0.2 cm × 0.1 cm × 0.15 cm)			The amount of milk was increased appropriately
July 15	Body weight: 1790 g; milk intake: 37 mL q3h		Discharge

UAC: Umbilical artery catheter; UVC: Umbilical venous catheter; HGB: Hemoglobin: HCT: Hematocrit; CRP: C-reactive protein; PICC: Peripherally inserted central catheter; APTT: Activated partial thromboplastin time; PCT: Procalcitonin; PT: Prothrombin time.