Sciatic palsy after umbilical catheterisation: brief report.

During 1949 and 1950, 38 cases of neonatal sciatic palsy after injection of umbilical vessels were described (Mills 1949. Hudson, McCandless and O’Malley 1950; McFarland 1950). Typically, paralysis was accompanied by ipsilateral discoloration of the buttock skin which progressed to scarring. McFarland (1950) proposed arterial thrombosis as the aetiology. The cause was thought to be mistaking one of the umbilical arteries for the vein, and injecting a thrombogenic analeptic drug into it. In a shocked neonate, retrograde arterial flow may carry a bolus injection into the inferior gluteal artery via the hypogastric and internal iliac arteries. The inferior gluteal artery supplies the upper part of the sciatic nerve and the overlying area of skin on the buttock. The administration of analeptic agents via the umbilical route declined markedly after these reports. A further and similar case was described by Shaw in 1960, but no other examples appear in the literature. A recent case is described in this report. Case report. A boy was delivered by breech presentation at 34 weeks’ gestation. Fetal distress merited intubation, ventilation and the insertion of an umbilical “venous” catheter. The following drugs were administered via the catheter in the first hour of life : 4 ml 4.2% bicarbonate solution, 30 ml plasma, 10 ml 10% dextrose solution, 1 mg dexamethasone, 30 mg phenobarbitone and 30 mg benzylpenicillin. Forty-five minutes after injection, “bruising “ of the right buttock, calf and heel became apparent. The child was noted not to move his right leg. Over the ensuing weeks, the cutaneous discoloration faded, leaving an area of slough, and later of dense scar tissue, in the right buttock. A right sciatic nerve palsy was diagnosed. At 1 1 months of age the scarred area was explored ; the two trunks of the sciatic nerve appeared normal and were free of scar. Since then the motor palsy