Ainsworth Sean, McGuire William
Directorate of Planned Care, NHS Fife, Victoria Hospital, Hayfield Road, Kirkcaldy, Fife, UK, KY2 5AH.
Cochrane Database Syst Rev. 2015 Oct 6;2015(10):CD004219. doi: 10.1002/14651858.CD004219.pub4.
Neonatal parenteral nutrition may be delivered via peripheral cannulas or central venous catheters (umbilical or percutaneous). As the result of complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters after initial stabilisation. Although they can be difficult to place, these catheters may be more stable than peripheral cannulae and require less frequent replacement. These delivery methods may be associated with different risks of adverse events, including acquired invasive infection and extravasation injury.
To determine the effects of infusion of parenteral nutrition via percutaneous central venous catheters versus peripheral cannulae on nutrient input, growth and development and complications among hospitalised neonates receiving parenteral nutrition in terms of adverse consequences such as bacteraemia or invasive fungal infection, cardiac tamponade or other extravasation injuries.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1966 to June 2015) and EMBASE (1980 to June 2015), as well as conference proceedings and previous reviews.
Randomised controlled trials that compared delivery of intravenous fluids (primarily parenteral nutrition) via percutaneous central venous catheters versus peripheral cannulae in hospitalised neonates.
We extracted data using standard methods of the Cochrane Neonatal Group, with separate evaluation of trial quality and data extraction by two review authors.
We found six trials recruiting a total of 549 infants. One trial showed that use of a percutaneous central venous catheter was associated with a smaller deficit between prescribed and actual nutrient intake during the trial period (mean difference (MD) -7.1%, 95% confidence interval (CI) -11.02 to -3.2). Infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae (MD -4.3, 95% CI -5.24, -3.43). Meta-analysis of data from all trials revealed no evidence of an effect on the incidence of invasive infection (typical risk ratio (RR) 0.95, 95% CI 0.72 to 1.25; typical risk difference (RD) -0.01, 95% CI -0.08 to 0.06).
AUTHORS' CONCLUSIONS: Data from one small trial suggest that use of percutaneous central venous catheters to deliver parenteral nutrition increases nutrient input. The significance of this in relation to long-term growth and developmental outcomes is unclear. Three trials suggest that use of percutaneous central venous catheters decreases the number of catheters/cannulae needed to deliver nutrition. No evidence suggests that percutaneous central venous catheter use increases risks of adverse events, particularly invasive infection, although none of the included trials was large enough to rule out an effect on uncommon severe adverse events such as pericardial effusion.
新生儿肠外营养可通过外周静脉套管或中心静脉导管（脐静脉或经皮穿刺）输注。由于脐静脉导管相关并发症，许多新生儿病房在初始稳定后更倾向于使用经皮穿刺导管。尽管这些导管可能难以放置，但它们可能比外周静脉套管更稳定，且更换频率更低。这些输注方式可能与不同的不良事件风险相关，包括获得性侵入性感染和外渗损伤。
确定在接受肠外营养的住院新生儿中，经皮中心静脉导管输注肠外营养与外周静脉套管输注相比，在营养输入、生长发育及并发症方面的影响，如菌血症或侵袭性真菌感染、心脏压塞或其他外渗损伤等不良后果。
我们检索了Cochrane对照试验中心注册库（CENTRAL；2015年第5期）、MEDLINE（1966年至2015年6月）和EMBASE（1980年至2015年6月），以及会议论文集和以往的综述。
比较住院新生儿经皮中心静脉导管与外周静脉套管输注静脉液体（主要是肠外营养）的随机对照试验。
我们采用Cochrane新生儿组的标准方法提取数据，由两位综述作者分别评估试验质量和提取数据。
我们找到6项试验，共纳入549名婴儿。一项试验表明，在试验期间，使用经皮中心静脉导管与规定营养摄入量和实际营养摄入量之间的差值较小有关（平均差值（MD）-7.1%，95%置信区间（CI）-11.02至-3.2）。经皮中心静脉导管组的婴儿所需的导管/套管显著更少（MD -4.3，95%CI -5.24，-3.43）。对所有试验数据的荟萃分析显示，没有证据表明对侵袭性感染的发生率有影响（典型风险比（RR）0.95，95%CI 0.72至1.25；典型风险差值（RD）-0.01，95%CI -0.08至0.06）。
一项小型试验的数据表明，使用经皮中心静脉导管输注肠外营养可增加营养输入。这对长期生长发育结局的意义尚不清楚。三项试验表明，使用经皮中心静脉导管可减少输送营养所需的导管/套管数量。没有证据表明使用经皮中心静脉导管会增加不良事件的风险，特别是侵袭性感染，尽管纳入的试验均不够大，无法排除对心包积液等罕见严重不良事件的影响。
