PERIPHERAL MEDIAN NERVE DAMAGE SECONDARY TO BRACHIAL ARTERIAL BLOOD GAS SAMPLING

In 1974, 252 infants with birth weights < 1501 g were referred to our neonatal intensive care unit. Arterial blood gases were monitored frequently to avoid the complications of hypo- and hyperoxia. Umbilical catheters were removed after 4 to 5 days; further arterial sampling was obtained preferentially from the right brachial artery. Eighty-nine percent (146/167) of the survivors have been examined prospectively to the age of 18 months post-term. Evidence of peripheral median nerve damage with mild to moderate impairment of the pincer grasp was found in 18 infants (12%). All had visually obvious scarring in the antecubital fossa secondary to arterial punctures. The right median nerve alone was affected in 13 cases; bilateral damage occurred in 5. The incidence of this lesion varied directly with the frequency of peripheral arterial punctures and indirectly with birth weight. An examination of autopsy tissue blocks of the antecubital fossa taken from 6 similarly treated infants revealed 4 with varying degrees of hemorrhage dissecting tissue planes. The most severe lesion demonstrated repeated extensive bleeding, muscle necrosis and a traumatic neuroma. A well defined pincer grasp is expected to be present by 12 months post-term; by 18 months post-term all peripheral regeneration of damaged nerve fibers should be completed. These results suggest that brachial arterial punctures may be associated with median nerve damage in the pre-term infant.