Umbilical artery catheters in the newborn: effects of position of the catheter tip.

BACKGROUND

This section is under preparation and will be included in the next issue.

OBJECTIVES

To determine whether the position of the tip of an umbilical arterial catheter influences the frequency of ischemic events, aortic thrombosis, intraventricular hemorrhage, mortality or necrotising enterocolitis in newborn infants.

SEARCH STRATEGY

Randomized and quasi randomized controlled trials of umbilical catheterization use were obtained from the following sources: 1. Effective Care of the Newborn Infant, edited by JC Sinclair and MB Bracken. 2. Medline Search using Melvyl Medline Plus and the keyword headings 'Umbilic#', 'Catheter#' and subject heading 'Infant, Newborn' 3. Search of personal data files

SELECTION CRITERIA

Randomized trials in newborn infants of any birthweight or gestation. Comparison of high catheter placement with the tip above the diaphragm to a lower position just above the aortic bifurcation. Clinically important end points such as ischemic events or aortic thrombosis.

DATA COLLECTION AND ANALYSIS

Five randomized controlled trials and one alternate assignment study had sufficiently detailed data to allow interpretation.

MAIN RESULTS

High placed umbilical artery catheters are associated with a lower incidence of clinical vascular complications, without an increase in any adverse sequelae. Intraventricular hemorrhage rates, death and necrotising enterocolitis are not more frequent with high compared to low catheters.

REVIEWER'S CONCLUSIONS: There appears to be no evidence to support the use of low placed umbilical artery catheters. High catheters should be used exclusively.