RESUMEN
Peripherally inserted central catheters (PICCs) play a critical role in neonatal intensive care units (NICUs), facilitating treatment in premature and critically ill neonates. However, achieving optimal PICC placement can present challenges, requiring meticulous monitoring and adjustment. Here, we describe the case of a 52-day-old, 1.9 kg preterm infant in the NICU requiring a central venous catheter for antibiotics and antifungals. Despite initial insertion into the basilic vein of the right forearm, imaging revealed the catheter's deviation into the right internal jugular vein. Leveraging the influence of arm position on catheter tip depth, external manipulation of the infant's right arm successfully repositioned the catheter tip into the superior vena cava (SVC). This case highlights the significant impact of arm positioning on PICC placement and underscores the efficacy of external extremity manipulation as a simple, non-invasive technique to adjust catheter position. Such innovative strategies offer promising alternatives to invasive interventions, emphasizing the importance of dynamic monitoring and adjustment techniques in neonatal PICC management.
RESUMEN
Oral clefts represent a significant craniofacial anomaly in neonates, presenting multifaceted challenges such as feeding difficulties, recurrent ear infections, speech impediments, poor growth, hearing impairments, and dental misalignments. These anomalies not only affect physical health but also have profound psychosocial implications for affected individuals and their families. Current management strategies aim to address these challenges comprehensively, and recent advancements in technology have offered innovative solutions. Among these, the integration of ultrasound-guided (USG) three-dimensional (3D)-constructed obturator devices has emerged as a promising approach to enhancing patient outcomes, particularly in achieving facial symmetry and facilitating early nutritional rehabilitation. This study presents a detailed case series of three term infants born to non-consanguineous parents with appropriate birth weights for their gestational age, each diagnosed with a unilateral cleft lip and palate (UCLP). The first infant also presented with left-hand polydactyly and a preauricular sinus, while the second was diagnosed with multicystic kidney disease based on kidney, ureter, and bladder (KUB) scan findings. Collaborating with the Smile Train organization and the maxillofacial surgery team, a comprehensive management plan was devised. In the initial phase, intraoral scanning (Medit Intraoral Scanner™, Seoul, South Korea; done at Saveetha Medical College and Hospitals, Chennai) and digital printing of the obturator plate were performed to capture precise anatomical details. Subsequently, 3D printing technology (Ender 3D Printer™, Creality, Shenzhen, China; done at Saveetha Medical College and Hospitals, Chennai) was employed to fabricate a customized obturator plate equipped with a nasal stent. This ultrasound (US)-guided 3D-constructed obturator device was designed to fit each infant's unique oral anatomy, providing optimal support and alignment. The implementation of this device within a week post birth played a pivotal role in expediting the initiation of direct breastfeeding and nutritional rehabilitation. Furthermore, one of the infants underwent cleft lip surgical repair at four months of age, showcasing the device's compatibility with subsequent surgical interventions. The utilization of US-guided 3D-constructed obturator devices in the management of cleft lip and palate (CLP) has demonstrated significant clinical benefits. These devices contribute to reduced facial deformities, mitigate nasal cartilage sagging, and foster enhanced weight gain. Additionally, they facilitate successful breastfeeding, thereby promoting early nutritional recovery. Moreover, the improved facial symmetry and cheek fullness resulting from this approach contribute to accelerated rehabilitation, thereby reducing the societal stigma often associated with craniofacial anomalies.