Sir.—The modern Neonatal Intensive Care Unit cares for increasing numbers of premature infants with birth weights below 1000 g. These infants usually require prolonged parenteral nutrition for survival. Increasingly, percutaneously inserted, small-diameter Silastic catheters are being used as alternatives to surgically placed central lines in high-risk neonates. Use of these intravascular lines is, however, not without hazard. This report describes a preterm infant who developed cardiac tamponade with a fatal outcome while receiving total parenteral nutrition via a Silastic central venous catheter.
Patient Report.—A 580-g preterm infant of 24 weeks' gestation was delivered to a 30-year-old woman with a hitherto normal pregnancy. Cesarean section was necessitated by severe antepartum hemorrhage. Exogenous bovine surfactant administered at birth reduced the fraction of inspired oxygen to 0.23 within a few hours of birth. A dopamine hydrochloride infusion was required during the first 36 hours of life to maintain a satisfactory blood