Association between Umbilical Catheters and Neonatal Outcomes in Extremely Preterm Infants

Elboraee, Mohamed; Toye, Jennifer; Xiang, Yu‐Tao; Shah, Prakesh S.; Aziz, Khalid

doi:10.1055/s-0037-1606607

Cited by 14 publications

(19 citation statements)

References 25 publications

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“…It is unclear how closely these guidelines are followed in clinical practice, particularly among neonates at the limits of viability. However, the days of UAC use observed are consistent with other recent reports [1,28]. Although catheter use was not prescribed in the present study, the variation in UAC days had the advantage of offering more robust statistical modeling to address our questions.…”

Section: Discussionsupporting

confidence: 91%

“…The presence of a UAC allows for easy, convenient access of direct arterial blood sampling and continuous blood pressure monitoring without the pain of heel stick capillary blood sampling. Despite these advantages, UACs carry the risk of thrombus formation, hypertension, central line-associated blood stream infections, and decreased cerebral perfusion during sampling [1][2][3][4]. Because of the ease of UAC use and its convenience for blood sampling, they have the potential to lead to unnecessary, more frequent blood sampling leading to increased phlebotomy blood loss (PBL).…”

Section: Introductionmentioning

confidence: 99%

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Neonatal Umbilical Arterial Catheter Removal Is Accompanied by a Marked Decline in Phlebotomy Blood Loss

et al. 2020

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Background: Umbilical arterial catheters (UACs) are frequently used in critically ill neonates. UAC are convenient, reliable, and allow for caregiver convenience in performing painless arterial blood sampling. We hypothesized that UAC removal in extremely low birth weight (ELBW) neonates will result in significantly less phlebotomy blood loss (PBL) after correcting for severity of illness. Study Design and Methods: PBL was measured at a single center in 99 ELBW infants who survived to day 28. Individual infant's paired daily PBL for the two 24-h periods before and after UAC removal were compared using the paired t test. Daily PBL up to 7 days before and 7 days after UAC removal were compared using a logistic regression with mixed model analysis for repeated measures. Cumulative 28-day phlebotomy loss was evaluated by multiple linear regression analysis. Results: PBL 24 h before and after UAC removal were 1.7 mL (95% CI 1.5-1.9) and 0.9 mL (95% CI 0.8-1.0; p < 0.0001), respectively. Cumulative 28day PBL increased by 2.2 mL (±0.7) per day that a UAC was present with or without correction for severity of illness (p < 0.001). Conclusion: UAC removal is independently associated with a marked decline in PBL. We speculate the ease and convenience of UAC blood sampling lead to more frequent blood testing and greater PBL.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Neonatal Umbilical Arterial Catheter Removal Is Accompanied by a Marked Decline in Phlebotomy Blood Loss

et al. 2020

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“…Neonates, especially those of extremely low gestational age, have an immature hemostatic system, vulnerable and narrow blood vessel diameter and overall are at higher-risk for adverse outcomes including ischæmic complications such as tissue necrosis and gangrene. ( Elboraee et al, 2018 , Dilli et al, 2015 , Beall et al, 2013 , Vasquez et al, 2003 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although limited to case reports and case series, there is growing evidence that TNG may be a promising therapeutic option for peripheral ischemia in infants ( Kim et al, 2020 , Elboraee et al, 2018 , Arshad and McCarthy, 2009 , Denkler and Cohen, 1989 ). To date, there are 27 published case reports and case series involving 76 infants about the use of TNG in the management of tissue ischemia in the neonatal population ( Table1 ).…”

Section: Discussionmentioning

confidence: 99%

Topical nitroglycerin in newborns with ischemic injuries: A systematic review

Mosalli

Khayyat

Qarni

et al. 2021

Saudi Pharmaceutical Journal

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Background Arterial catheterization is frequently performed in neonatal intensive care units with an inherent risk of peripheral ischemic injury, especially in preterm infants. The treatment options following vascular damage involve invasive and non-invasive modalities. The primary objective of this systematic review was to evaluate the evidence of the use of topical nitroglycerine (TNG) either alone or as adjunctive therapy. The secondary aim was to develop an approach to the treatment of catheter induced ischemia in infants based on the available evidence. Methods A comprehensive search was conducted of available databases for relevant articles that involved the treatment of peripheral tissue ischemia in neonates with the use of TNG. Citations were restricted to human subjects. Results Six hundred and eighty-nine articles were identified, and twenty-seven case reports and case series were compatible with the inclusion and exclusion criteria. Sixty-eight infants out of the 76 published cases (89%) experienced a favorable outcome and 79% (n = 60) demonstrated complete recovery with the topical application of TNG to the ischemic site. Conclusion The available evidence demonstrates that TNG is effective for the treatment of peripheral ischemia in neonates after standard conservative measures have failed. However, due to the absence of robust evidence for this therapeutic modality, there are no uniform guidelines regarding the frequency, duration, and safety of TNG use. Planning the management of peripheral ischemia in neonates with TNG should be a multidisciplinary decision that includes close surveillance of blood pressure, methemoglobin levels, and follow up cranial ultrasound.

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“…Traditionell werden in der Neonatologie Nabelarterienkatheter (NAK) zur arteriellen Kanülierung genutzt [1]. Komplikationen von NAK sind aber in der Literatur gut beschrieben und umfassen Sepsis, Thrombosen, Embolien und die Bildung von Aneurysmata in der Aorta [2][3].…”

Section: Pflege Von Peripheren Arterienzugängen Bei Extrem Unreifen Frühgeborenenunclassified

Pflege von peripheren Arterienzugängen bei extrem unreifen Frühgeborenen

Bruck¹,

Rose²,

Seipolt³

et al. 2021

JuKiP - Ihr Fachmagazin für Gesundheits- und Kinderkrankenpfleg

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Wenn ein Leben viel zu früh beginnt, beispielsweise mit 24 Schwangerschaftswochen, prasseln tausend Eindrücke auf solch ein kleines Lebewesen ein. Die extrem unreifen Frühgeborenen sind trotz entwicklungsfördernder Pflege rund um die Uhr stressigen Situationen, zum Beispiel wiederkehrenden Blutabnahmen ausgesetzt. Können Frühgeborene von einem peripheren arteriellen Gefäßzugang profitieren, indem Schmerzen reduziert und das Monitoring optimiert werden? Welche Besonderheiten sind bei peripheren Arterienzugängen extrem unreifer Frühgeborener zu beachten?

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Association between Umbilical Catheters and Neonatal Outcomes in Extremely Preterm Infants

Abstract: Most of the infants born at <29 weeks' gestation had UVC and/or UAC placement. The presence of either catheter was associated with mortality or major morbidity, and the association was stronger when both catheters were present.

Cited by 14 publications

References 25 publications

Neonatal Umbilical Arterial Catheter Removal Is Accompanied by a Marked Decline in Phlebotomy Blood Loss

Neonatal Umbilical Arterial Catheter Removal Is Accompanied by a Marked Decline in Phlebotomy Blood Loss

Topical nitroglycerin in newborns with ischemic injuries: A systematic review

Pflege von peripheren Arterienzugängen bei extrem unreifen Frühgeborenen

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