A Randomized Trial Comparing Long-term and Short-term Use of Umbilical Venous Catheters in Premature Infants With Birth Weights of Less Than 1251 Grams

Butler-O’Hara, Meggan; Buzzard, Carol J.; Reubens, Linda J.; McDermott, Michael P.; DiGrazio, William J.; D’Angio, Carl T.

doi:10.1542/peds.2005-1880

Cited by 142 publications

(116 citation statements)

References 34 publications

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“…Individual studies have revealed an increased risk of infection when a UVC is used for more than 5 to 7 days and when a PICC is used for .35 days [24][25][26] ; however, a head-tohead comparison is lacking. Butler-O'Hara et al 31 compared prolonged UVC use to the current practice of combined use of a UVC followed by a PICC after 5 to 7 days if access is still required. The authors concluded that PICCs and UVCs have the same rate of sepsis in the first few days after birth, but that a PICC was less likely to be infected after 7 days of indwelling.…”

Section: Figurementioning

confidence: 99%

“…The authors concluded that PICCs and UVCs have the same rate of sepsis in the first few days after birth, but that a PICC was less likely to be infected after 7 days of indwelling. 31 The portal for entry of an infectious organism with either a UVC or PICC is the catheter hub. Microorganisms are introduced predominantly through the hub during routine use or at the time of catheter insertion.…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates

Shalabi¹,

Adel²,

Yoon³

et al. 2015

Pediatrics

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OBJECTIVE: To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks’ gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. METHODS: This retrospective matched cohort study examined data from infants born at <30 weeks’ gestation and admitted between January 2010 and December 2013 to neonatal units in the Canadian Neonatal Network. Eligible infants who received a PICC on the first day after birth (day 1) were matched with 2 additional groups of infants, those who received a UVC on day 1 and those who received a UVC on day 1 that was then changed for a PICC after 4 days or more. The primary outcome was number of infants with CABSI per 1000 catheter days, which was compared between the 3 groups using multivariable analyses. RESULTS: Data from 540 eligible infants were reviewed (180 per group). There was no significant difference in infants with CABSI/1000 catheter days between the 3 groups (9.3 vs 7.8 vs 8.2/1000 catheter days, respectively; P > .05) despite lower rates of late onset sepsis in the group of infants who received only a UVC. CONCLUSIONS: There was no significant difference in the incidence of CABSI between very preterm neonates who received a PICC, UVC, or UVC followed by PICC as the primary mode of venous access after birth. A prospective randomized controlled trial is justified to further guide practice regarding primary venous access and reduction of infection.

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates

Shalabi¹,

Adel²,

Yoon³

et al. 2015

Pediatrics

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“…While the length of usage of the UVC is recommended by the CDC to be less than 10 days, 21 a recent randomized controlled trial could not endorse this finding. 22 Regarding potential bias, we used a consecutive cohort of clinical population and culture-proven infection as reference standard. Therefore, it was unlikely that we overestimated the LNS score predictive performance.…”

Section: Discussionmentioning

confidence: 99%

External validation of bedside prediction score for diagnosis of late-onset neonatal sepsis

et al. 2007

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Objective: To prospectively validate performance of a prediction score for diagnosis of late-onset neonatal sepsis (LNS) in a new patient population. Result: A total of 105 neonates were evaluated for sepsis. Demographic characteristics were as follows: (mean (s.d.)) were gestational age (GA) 29 (3) weeks; birth weight (BW) 1232 (620) g and postnatal age 17.5 day (12). Thirty-five (33%) neonates had LNS (35 positive blood cultures; 2 positive CSF). No significant differences in GA, BW, gender, age and central line utilization were found between LNS positive and LNS negative groups. Using a cut-off score of p3, the score predicted positive culture with sensitivity of 0.97 (95% confidence interval 0.85, 0.99) and a negative likelihood ratio of 0.07. The discrimination and calibration ability of LNS score was acceptable. Conclusion:A simple clinical decision rule previously developed to predict LNS performs equally in an independent population and NICU.

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“…68 A randomized trial compared long-term UVC use (up to 28 days) with short-term (7 to 10 days) use followed by peripheral CVL placement; investigators found that in the short-term group, 9% developed thrombi with 4% being clinically significant compared with 13 and 7%, respectively, in the long-term group. 69 Therefore, although rates were similar, limiting UVC use to as short a period as possible is recommended. 69 The gold standard for diagnosing venous TE is venogram, however, this modality is difficult in neonates, especially premature infants, due to poor venous access, lower glomerular filtration rates and rapid dispersion times due to increased cardiac output.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…69 Therefore, although rates were similar, limiting UVC use to as short a period as possible is recommended. 69 The gold standard for diagnosing venous TE is venogram, however, this modality is difficult in neonates, especially premature infants, due to poor venous access, lower glomerular filtration rates and rapid dispersion times due to increased cardiac output. 18 As a result, US is the most widely and safely used modality.…”

Section: Venous Thrombosismentioning

confidence: 99%

The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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In the pediatric population, neonates have the highest risk for thromboembolism (TE), most likely due to the frequent use of intravascular catheters. This increased risk is attributed to multiple risk factors. Randomized clinical trials dealing with management of postnatal thromboses do not exist, thus, opinions differ regarding optimal diagnostic and therapeutic interventions. This review begins with an actual case study illustrating the complexity and severity of these types of cases, and then evaluates the neonatal hemostatic system with discussion of the common sites of postnatal thrombosis, perinatal and prothrombotic risk factors, and potential treatment options. A proposed step-wise evaluation of neonates with symptomatic postnatal thromboses will be suggested, as well as future research and registry directions. Owing to the complexity of ischemic perinatal stroke, this topic will not be reviewed. Case study A full-term male infant born through spontaneous vaginal delivery was admitted to the neonatal intensive care unit (NICU) shortly after birth due to a history of low APGAR scores and respiratory distress requiring mechanical ventilation. The pregnancy was complicated by gestational diabetes treated with glyburide and chorioamnionitis was evident during labor. The patient was started on ampicillin and gentamicin and appropriate fluid resuscitation was initiated. The patient improved over the next few days and was able to be weaned off of ventilator support. The patient had an umbilical arterial catheter (UAC) placed after birth that was removed on day 3 of life.On day 4 of life the patient's legs appeared pale. Physical examination demonstrated cool lower extremities and markedly decreased pulses in the feet. Over the previous 24 h, urine output declined significantly.Ultrasound (US) examination of the heart, major vessels and abdomen demonstrated a large thrombus in the descending aorta with very minimal flow to the renal and iliac arteries. A literature search did not reveal any level I management guidelines for thrombosis in neonatal patients, and consideration is now given to surgical thrombectomy, anticoagulation therapy or fibrinolytic therapy. Incidence of neonatal thromboembolic diseaseAlthough neonates have the highest risk of thromboembolism (TE) in the pediatric population, the incidence of postnatal TE varies due to the types of thromboses that were reported and how aggressively centers screened for thromboses. 1 Data from the three international registries are displayed in Table 1. All three registries observed that thromboses occurred in both term and preterm infants and affected male and female infants equally, other than renal vein thrombosis (RVT) that affected more male neonates. [2][3][4] These registries also demonstrated that approximately 90% of venous thromboses in neonates were associated with central venous catheters (CVLs). [2][3][4] The recurrence rate of TE following symptomatic neonatal events ranges from 3.3 to 7%. 5 The international registries are the first step toward...

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A Randomized Trial Comparing Long-term and Short-term Use of Umbilical Venous Catheters in Premature Infants With Birth Weights of Less Than 1251 Grams

Cited by 142 publications

References 34 publications

Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates

Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates

External validation of bedside prediction score for diagnosis of late-onset neonatal sepsis

The evaluation and management of postnatal thromboses

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