Quality Improvement Initiative for Neonates: Use of In-line Endotoxin Filters in Central Venous Catheters: A Prospective Interventional Study

Abstract

Introduction: Sick newborns often require central venous catheters for prolonged periods of time when admitted to the Neonatal Intensive Care Unit (NICU). These central lines, hence, raise the problems of sepsis, thrombus and other potential linerelated complications. In-line endotoxin filters are found to be an effective intervention to remove potential sepsis causing bacteria, endotoxins and other particulates there by reducing the mortality and morbidity of these newborns. Aim: To determine the effect of in-line endotoxin filters on mortality and occurrence of venous thrombosis, sepsis and Necrotising Enterocolitis (NEC) in sick newborns with central venous catheters. Materials and Methods: This single-centre, prospective interventional study was conducted over a period of 12 months, where, all sick babies admitted to the NICU for more than 24 hours with a central venous catheter were eligible for the study. They were grouped into those which received the in-line filters (study group) and those with standard care without filters (control group). The primary outcome variables studied were sepsis, thrombus formation, NEC, ventilator days and death. Secondary outcomes were days of hospital stay, line days, and length of ICU stay. Results: Out of 137 eligible neonates, 127 were finally included in the study; 66 were in the control group while 61 in the study group, seven were excluded and a total of 54 in the study group were included. A total of 20 cases developed NEC in the control group while only six in the study group (p-value=0.03). Thrombus formation was lesser in the study group 3 (5.6%) compared to the control group 14 (21.2%). Thrombus formation was also found to be less likely to occur when an in-line filter is attached as compared to not using one (OR 0.232; 95% CI 0.628-0.858; p-value=0.02). The odds of occurrence of NEC (OR: 0.307 95 % CI: 0.113 - 0.834) also were found to be significantly less in the study group. Conclusion: A simple intervention like addition of in-line endotoxin filters to the central venous catheters in sick newborns in NICU decreases the risk of thrombosis, risk of NEC and overall complications in critically ill NICU patients.