Case 2: An Uncommon Peripherally Inserted Central Catheter Position with an Uncommon Diagnosis

Presentation

A 30-week-gestation preterm male infant is born via an emergency lower segment cesarean section because of pregnancy-induced hypertension and the absence of end-diastolic flow in the umbilical artery. The mother is 35 years old, had regular antenatal visits, primigravida, and a known case of hypothyroidism for which she is receiving treatment. During this pregnancy, the mother had pregnancy-induced hypertension for which she was treated with labetalol. At birth, the infant has a poor cry and poor respiratory effort requiring continuous positive airway pressure mechanical ventilation, and his Apgar scores are 7 and 9 at 1 minute and 5 minutes, respectively, so he is transferred to the NICU with the administration of continuous positive airway pressure (CPAP) ventilation. His growth parameters include a weight of 1.13 kg (just above the 10th percentile), length 37 cm (just below the 10th percentile), and head circumference 28.5 cm (at the 50th percentile). In the NICU, the respiratory distress worsens and he requires full ventilation. Because of the need for total parental nutrition as well as other medications, a peripherally inserted central catheter (PICC) was inserted in the left upper limb, and chest radiography performed to confirm …