Introduction Umbilical vein catheterization is a common method for obtaining venous access for diagnostic and therapeutic procedures in the neonate. This is particularly true in neonates < 1000 g in weight, where as many as 50 % will have an umbilical vein catheter (UVC) placed [1]. While of great value in the care of these infants, UVCs are not without risk. There are many complications of umbilical vein catheterization [2±9], including a single prior report of ascites from extravasation of total par- enteral nutrition (TPN) [10]. Over the last three years we have seen eight patients presenting with abdominal distension after intraperitoneal extravasation of TPN infused through malpositioned UVCs. Index case This female infant was born at 27 weeks weighing 955 g with Apgar scores of 5 and 7 at one and five minutes, respectively. A 5F-UVC was placed without complication, the tip located at the level of T10 on radiographs, superimposed over the liver. TPN was started on day of life 3 with 5 % dextrose, 1.65 % amino acids, and lipids. On day of life 10, she developed abdominal distension and respira- tory distress (Fig. 1). Ultrasound on day of life 11, performed due to suspicion of ascites on plain film, showed free fluid within the Brian D. Coley John Seguin Leandro Cordero Mark J. Hogan Ellen Rosenberg Kris Reber Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters Received: 26 February 1998 Accepted: 29 June 1998 Presented in part at the 40th annual meet- ing of the Society for Pediatric Radiology, St. Louis, Missouri, May 1997 B. D. Coley ( ) ) × M. J. Hogan Department of Radiology, Children's Radiological Institute and Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA J. Seguin × L. Cordero × E. Rosenberg 1 × K. Reber Department of Neonatology, Columbus Children's Hospital and The Ohio State University Hospital Columbus, Ohio, USA Present address: 1 Department of Pediatrics, Texas Tech University, Health Sciences Center, Lub- bock, Texas, USA Abstract Background. A preterm infant was found to have total par- enteral nutrition (TPN) ascites after infusion through a low umbilical vein catheter (UVC). Objective. To evaluate the clinical and imaging findings of neonates with TPN ascites after infusion through UVCs. Materials and methods. Eight pa- tients with TPN ascites were identi- fied over three years. Charts were abstracted for clinical data. Plain- film, ultrasound (US), and contrast studies through the UVCs were ex- amined to determine UVC place- ment, presence of liver injury, and confirmation of intraperitoneal ex- travasation from the UVC. Results. All eight patients with TPN ascites presented with hypotension and abdominal distension. All had UVCs overlying the liver on plain film. Catheters were in place a mean of 8.9 days prior to TPN extravasa- tion. US in four patients showed he- patic parenchymal damage around the UVC tip. Contrast studies in six patients showed intraperitoneal spill. Conclusion. While low UVC place- ment may sometimes be clinically unavoidable, TPN administered through abnormally positioned UVCs is not without risk. Pediatr Radiol (1998) 28: 923±927 Ó Springer-Verlag 1998