Mesh : Abnormalities, Multiple / surgery Animals Anti-Bacterial Agents / therapeutic use Enteral Nutrition / instrumentation Equipment Design Hernia, Diaphragmatic / surgery Hernias, Diaphragmatic, Congenital Herniorrhaphy Humans Hypoxia / blood etiology Infant Infusions, Intravenous Intensive Care Units, Pediatric Intubation, Gastrointestinal Male Medication Errors Milk / adverse effects Oximetry Oxygen Inhalation Therapy Postoperative Complications / etiology Tachycardia / etiology Tachypnea / etiology

来  源:   DOI:10.1186/1756-0500-7-17   PDF(Sci-hub)

Abstract:
BACKGROUND: Accidental intravenous administration of an enteral feeding can be fatal or cause complications such as sepsis, acute respiratory and circulatory failure, acute renal failure, hepatic insufficiency, coagulation disorders and severe permanent neurological sequelae. These \"wrong route\" errors are possible due to compatible connections between enteral feeding systems and intravascular infusion catheters.
METHODS: We report a six-week-old male infant who received a 5 ml intravenous infusion of breast milk. Within five minutes of administration the child developed tachycardia and tachypnea, accompanied by a sudden decrease in oxygen saturation on pulse oximetry to 69%. The infant received supplemental oxygen via nasal cannula and was transferred to the pediatric intensive care unit. Broad-spectrum antibiotics were administered for 48 hours. Vital signs returned to normal within a few hours. Neurological follow-up through 3 years did not reveal any neurodevelopmental abnormalities.
CONCLUSIONS: Development of specific enteral feeding connections, which are incompatible with intravascular catheter connections, is needed urgently to prevent a misconnection with potential morbidity or mortality of children.
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