A single, preterm (28 wk), female, 914 g birth weight was admitted at 7 h of life with severe hypothermia, apnea and shock due to suspected early onset neonatal sepsis. Mechanical ventilation with empirical antibiotics (Cefotaxime and Amikacin) were started and on investigation had negative sepsis screen, sterile blood culture and normal bedside USG cranium. On day 8, the baby developed sclerema, coagulopathy and acute kidney injury (AKI). Repeat blood culture showed growth of Klebsiella pneumoniae sensitive to piperacillin-tazobactum. Antibiotics were revised and double volume exchange transfusion was done for severe sepsis with sclerema, and peritoneal dialysis (PD) was performed using a 2.5 size endotracheal tube (ETT) on day 10 of life. The ETT was cut to a proper length and some small side holes were made on the ETT with a surgical blade. The peritoneal cavity was then inflated with PD fluid using a 22 G intravenous cannula. A small infraumbilical midline knick was given with a surgical blade, through which the 2.5 size ETT was introduced to fix in the left pelvic cavity and the PD set was connected. PD was successfully continued for 18 h without complications except for minimal leakage by the side of the catheter, before the baby expired on day 11 of life.

There are reports of using different materials such as a large bore IV cannula [1], vascular catheter [2], neonatal single-cuff straight catheter (Tenckhoff) [3], angiocath [4] etc. as PD catheters in neonates. Things like vascular catheters and other materials may not be easily available in all neonatal ICUs, but a 2.5 size ETT is an easily available thing in all neonatal settings. As PD can serve as a life-saving procedure at times, in resource constraint situation, one can easily use a 2.5 size ETT as access for PD in neonates as an alternative.