An infected subdural collection of intravenous fat emulsion (Intralipid) was diagnosed in a 5-week-old premature infant who was receiving total parental nutrition (TPN) through a facial vein cutdown. This fluid was successfully drained and the infection, due to Staphylococcus epidermidis, was treated with vancomycin. We postulate that the subdural collection occurred as a result of septic thrombosis of the internal jugular vein with subsequent retrograde flow and infiltration of Intralipid from the bridging veins into the subdural space. This complication of central TPN has not been reported previously.
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References
1.
Dhande V., Kattwinkel J., Alford B.Recurrent bilateral pleural effusions secondary to superior vena cava obstruction as a complication of central venous catheterization. Pediatrics1983;72:109-13.
Ryan, JA, Abel RM, Abbott WM, et al. Catheter complications in total parenteral nutrition. N Engl J Med1974;290:757-61.
4.
Heird WC, MacMillan RW, Winters RWTotal parenteral nutrition in the pediatric patient. In: Fischer JE, ed. Total parenteral nutrition . Boston: Little, Brown, and Co , 1976;253-84.
5.
Zumbro GL, Mullin MJ, Nelson TGCatheter placement in infants needing total parenteral nutrition utilizing common facial vein. Arch Surg1971; 102:71-3.
6.
Loeff DS, Matlak ME, Black RE, et al. Insertion of a small central venous catheter in neonates and young infants. J Pediatr Surg1982;17:944-8.
7.
Johnson DGTotal intravenous nutrition in newborn surgical patients: a three-year perspective . J Pediatr Surg1979;5:601-5.
8.
American Academy of Pediatrics, Committee on Nutrition. Commentary on parenteral nutrition. Pediatrics1983 ;71:547-52.
9.
Fonkalsrud EW , Ament ME, Berquist WE, et al. Occlusion of the vena cava in infants receiving central venous hyperalimentation. Surg Gynecol Obstet1982;154:189-92.
10.
Zumbro GL, Mullin MJ, Nelson TGCentral venous catheter placement utilizing common facial vein. Am J Surg1973;125:654-6.
11.
Ryan JAComplications of total parenteral nutrition. In Fischer JE, ed. Total parenteral nutrition . Boston: Little, Brown, and Co1976 :55-100.
12.
Groff DBComplications of intravenous hyperalimentation in newborns and infants . J Pediatr Surg1969;4:460-4.
13.
Opitz JC, Toyama W.Cardiac tamponade from central venous catheterization: two cases in premature infants with survival. Pediatrics1982;70:139-40.
14.
Stewart DR, Johnson DG, Meyers GGHydrocephalus as a complication of jugular catheterization during total parenteral nutrition. J Pediatr Surg1975; 10:771-6.
15.
Haar FL, Miller CAHydrocephalus resulting from superior vena cava thrombosis in an infant . J Neurosurg1975;42:597-601.
16.
Newman LJ, Heitlinger L., Hiesiger E., et al. Communicating hydrocephalus following total parenteral nutrition . J Pediatr Surg1980;15:215-7.
17.
Riordan TPPlacement of central venous lines in the premature infant. JPEN1979;3:381-2.
18.
Rabe EFSubdural effusions in infants. Pediatr Clin North Am1967;14:831-50.
19.
Rabe ER, Flynn RE, Dodge PRSubdural collections of fluid in infants and children. Neurology1968;18:559-70.
