Association between Umbilical Catheters and Neonatal Outcomes in Extremely Preterm Infants
28 May 2017
12 August 2017
14 September 2017 (eFirst)
Objective The objective of this study was to examine the association between umbilical catheters and a composite outcome of mortality or major neonatal morbidity in extremely preterm infants.
Study Design Data were abstracted from the Canadian Neonatal Network database for infants born at <29 weeks' gestational age and admitted to 29 neonatal intensive care units between January 2010 and December 2012. Four groups were identified: those with no umbilical catheters, umbilical venous catheters (UVCs), umbilical artery catheters (UACs), and those with both UVCs and UACs. The outcomes were compared among the groups using univariate and multivariable analyses.
Results Of 4,623 eligible infants, 820 (17.7%) had no catheters, 1,032 (22.3%) a UVC only, 120 (2.6%) a UAC only, and 2,651 (57.3%) had both catheters. After adjustment for acuity and other potential confounders, umbilical catheters were associated with higher odds of mortality or any major morbidity (UVC vs. no catheter: adjusted odds ratio [aOR]: 1.47; 95% CI: 1.18–1.85; UAC vs. no catheter: aOR: 1.67; 95% CI: 1.05–2.63; and both UVC + UAC vs. no catheter: aOR: 2.17; 95% CI: 1.79–2.70).
Conclusion 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.
Keywordsumbilical catheters - extremely preterm infants - neonatal outcomes - mortality or any major morbidity - Canadian Neonatal Network
Mohamed S. Elboraee conceptualized the study, developed the data collection sheet, drafted the initial article, involved in data analysis, and approved the final article as submitted. Khalid Aziz, Jennifer Toye, and Prakesh S. Shah were involved in study design, data analysis, review of the article, and approved the final article as submitted. Xiang Y. Ye performed the statistical analyses, reviewed the article, and approved the final article as submitted. All authors approved the final article as submitted and agree to be accountable for all aspects of the work.
This work was supported by seed funding opportunity from the Department of Pediatrics, University of Alberta. Organizational support was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by grant funding from the Canadian Institutes of Health Research (FRN87518) and in kind support from Mount Sinai Hospital, Toronto, Ontario. Dr. Shah holds an applied research chair in Reproductive and Child Health Services and Policy Research awarded by the Canadian Institutes of Health Research (APR-126340).
- 1 Hermansen MC, Hermansen MG. Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol 2005; 32 (01) 141-156 , vii
- 2 Shahid S, Dutta S, Symington A, Shivananda S. ; McMaster University NICU. Standardizing umbilical catheter usage in preterm infants. Pediatrics 2014; 133 (06) e1742-e1752
- 3 Loisel DB, Smith MM, MacDonald MG, Martin GR. Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines. J Perinatol 1996; 16 (06) 461-466
- 4 Butler-O'Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D'Angio CT. 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. Pediatrics 2006; 118 (01) e25-e35
- 5 Lee JH. Catheter-related bloodstream infections in neonatal intensive care units. Korean J Pediatr 2011; 54 (09) 363-367
- 6 Oelberg DG, Baker A, Quast D, Worley L. Impact of umbilical catheterization on morbidity and mortality in extremely premature newborns. J Neonatal Perinatal Med 2014; 7 (01) 13-19
- 7 Chien LY, Macnab Y, Aziz K, Andrews W, McMillan DD, Lee SK. ; Canadian Neonatal Network. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002; 21 (06) 505-511
- 8 Canadian Neonatal Network. Abstractor's Manual v2.1.4. 2015 . Available at: http://www.canadianneonatalnetwork.org/Portal/LinkClick.aspx?fileticket=25XSctUHSzE%3d&tabid=69 . Accessed January 2016
- 9 Freeman J, Epstein MF, Smith NE, Platt R, Sidebottom DG, Goldmann DA. Extra hospital stay and antibiotic usage with nosocomial coagulase-negative staphylococcal bacteremia in two neonatal intensive care unit populations. Am J Dis Child 1990; 144 (03) 324-329
- 10 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
- 11 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82 (04) 527-532
- 12 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
- 13 International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
- 14 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (01) 92-100
- 15 Nash P. Umbilical catheters, placement, and complication management. J Infus Nurs 2006; 29 (06) 346-352
- 16 Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine, 6th ed. Philadelphia: Elsevier; 2014
- 17 Rennie JM, Kendall G. A Manual of Neonatal Intensive Care, 5th ed. Boca Raton: CRC Press; 2013
- 18 Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol 2011; 32 (01) 42-49
- 19 Gephart SM, McGrath JM, Effken JA, Halpern MD. Necrotizing enterocolitis risk: state of the science. Adv Neonatal Care 2012; 12 (02) 77-87 , quiz 88–89
- 20 Landers S, Moise AA, Fraley JK, Smith EO, Baker CJ. Factors associated with umbilical catheter-related sepsis in neonates. Am J Dis Child 1991; 145 (06) 675-680
- 21 O'Grady NP, Alexander M, Burns LA. , et al; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52 (09) e162-e193
- 22 Hüning BM, Horsch S, Roll C. Blood sampling via umbilical vein catheters decreases cerebral oxygenation and blood volume in preterm infants. Acta Paediatr 2007; 96 (11) 1617-1621
- 23 Roll C, Hüning B, Käunicke M, Krug J, Horsch S. Umbilical artery catheter blood sampling volume and velocity: impact on cerebral blood volume and oxygenation in very-low-birthweight infants. Acta Paediatr 2006; 95 (01) 68-73
- 24 Schulman J, Stricof R, Stevens TP. , et al; New York State Regional Perinatal Care Centers. Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011; 127 (03) 436-444
- 25 Garland JS, Dunne Jr WM, Havens P. , et al. Peripheral intravenous catheter complications in critically ill children: a prospective study. Pediatrics 1992; 89 (6 Pt 2): 1145-1150
- 26 Polin RA, Lisa Saiman L. Nosocomial infections in the neonatal intensive care unit. Neoreviews 2003; 4 (03) e81-e89
- 27 Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK. ; Canadian Neonatal Network. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics 2012; 129 (02) e298-e304
- 28 Boo NY, Wong NC, Zulkifli SS, Lye MS. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health 1999; 35 (05) 460-465