By Crina Frincu-Mallos, PhD
WASHINGTON, DC -- October 20, 2009 -- Maintaining umbilical venous catheters (UVCs) for more than 7 days in neonates with low birth weight results in a 4-fold increase in their risk of sepsis, according to preliminary data reported here at the 2009 American Academy of Pediatrics (AAP) National Conference & Exhibition.
"Central line-associated blood stream infections [CLABSIs] and CLABSI case fatalities were significantly increased in low birth weight neonates when UVCs were not removed before 7 days of age," said Noelle Gabriel, MD, Eastern Virginia Medical School, Norfolk, Virginia, on October 16.
This study was performed in collaboration with staff from Children's Hospital of the King's Daughters, Norfolk, Virginia.
"In 2002, the Hospital Infection Control Practices Advisory Committee of the CDC [Centers for Disease Control and Prevention] recommended that umbilical venous catheters be removed from neonates as soon as possible, optimally before 14 days of use," said Dr. Gabriel.
However, later studies reported that infection rates in neonates were similar if UVCs were used long-term (up to 28 days), compared with UVCs replaced after 7-10 days by peripherally inserted central catheters (PICCs), suggesting that UVC use beyond 14 days may be reasonable.(1)
"Hence, there is controversy as to when UVCs should be removed," explained Dr. Gabriel.
Dr. Gabriel and colleagues aimed to elucidate the correlation between birth weight and the duration of use of UVCs and PICCs. They focused further on the rate of CLABSIs associated with the length of UVC and PICC use, especially in neonates with extremely low birth weight (ELBW; <=1,000 g).
Between November 2006 and October 2008, there were 272 UVCs in neonates with ELBW. Twenty-three (8%) developed CLABSIs.
Notably, CLABSIs developed in only 3 of the 88 UVCs removed before 7 days, compared with 20 (11%) of the 184 UVCs removed after more than 7 days.
"There was no significant difference in birth weight or gestational age between the ELBW infants with UVCs removed before 7 days compared with the UVCs removed after 7 days," said Dr. Gabriel.
"There were no CLABSI case fatalities in UVCs removed before 7 days," said Dr. Gabriel, adding that "all 9 fatalities due to sepsis occurred in UVCs which were removed on day 7 or later, giving a case-fatality rate of 39%," (P = .04; odds ratio = 3.5; 95% confidence interval, 1-12).
During the same time frame, there were 361 PICCs in ELBW infants. During the first year, there were 29 CLABSIs in 191 neonates with PICCs. In the second year of the study, the number of infections decreased to 12 in the 170 neonates with PICCs.
"We observed a significant reduction [P = .02] in PICC CLABSI infections between the first and the second year of the study."
This significant reduction in infections in ELBW neonates with PICCs was attributed to the comprehensive program to decrease CLABSIs in the neonatal intensive care unit, remarked Dr. Gabriel, adding that "a CLABSI prevention coordinator and a comprehensive prevention bundle, including chlorhexidine for hub and skin antisepsis, were needed to minimise CLABSIs with PICC lines in these infants."
Dr. Gabriel concluded that UVCs in ELBW neonates should be removed within a week from first use and/or replaced by PICCs, if central venous access is required.
Funding for this study was provided by the Executive Board of Children's Hospital of the King's Daughters Health System.
1. Butler-O'Hara M et al. Pediatrics 2006;118:e25-e35.
[Presentation title: The Risk of Sepsis Increases Four-Fold in Extremely Low Birth Weight Infants If Umbilical Venous Catheters Are Not Removed Before Seven Days of Age. Abstract 7455]
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