Umbilical artery catheters in the newborn: effects of catheter design (end vs side hole).

BACKGROUND

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

OBJECTIVES

To determine whether the design 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 end hole catheters with side hole catheters. Clinically important end points such as ischemic events or aortic thrombosis.

DATA COLLECTION AND ANALYSIS

There appears to be only a single trial which has addressed this issue (Wesstrom 1979).

MAIN RESULTS

End hole catheters are associated with a much decreased risk of aortic thrombosis compared to side hole catheters. RR = 0.27 (95% CI 0.11, 0.67)

REVIEWER'S CONCLUSIONS: Side hole catheters should be avoided for umbilical arterial catheterisation in the newborn.