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April 1981

Paralysis of Diaphragm Complicating Central Venous Alimentation

Author Affiliations

Neonatal-Respiratory Disease Division Childrens Hospital of Los Angeles 4650 Sunset Blvd Los Angeles, CA 90027

Am J Dis Child. 1981;135(4):382. doi:10.1001/archpedi.1981.02130280072028

Central venous alimentation has been used extensively in neonates with intestinal disorders and intolerance of enteral feeding.1 However, use of a central venous catheter for parenteral nutrition is occasionally associated with severe complications.2 Superior vena cava thrombosis,3 hydrothorax from fluid extravasation,4 and paralysis of the hemidiaphragm due to direct laceration of the phrenic nerve5-7 have been observed. Our patient had diaphragmatic paralysis secondary to extravasation of parenteral alimentation solution.

Report of a Case.—The patient was born after 36 weeks' gestation weighing 2 kg; she had Apgar scores of 1 at 1 minute and 5 at 5 minutes of age. Necrotizing enterocolitis developed on the 20th day of life and required ileal resection. Subsequently, two further episodes of necrotizing enterocolitis developed and were managed conservatively. Central venous catheterization via the right external jugular vein was performed for the administration of total parenteral nutrition. The