Letters to the Editor

Indian Pediatrics 2002; 39:209  

The Dilemma of Removing Umbilical Venous Catheters in High-risk Neonates with Nosocomial Sepsis

Umbilical venous catheters (UVC) used during the first two weeks of life provide a relatively safe, less stressful, cost-effective means of providing prolonged, secure intravenous (IV) access in neonates(1). The rising need of and the technical difficulties in providing such an access cannot be over-emphasized given the improving survival of extremely low birth weight (ELBW) neonates. The issue is further complicated by catheter related sepsis (CRS) with an incidence ranging from 3.5 to 5%(2). Multiple attempts at insertion followed by epidermal stripping related to the taping of IV catheters is a significant factor in the etiology of noso-comial sepsis in ELBW neonates. Recently umbilical catheterization, both venous and arterial for >5 days was reported to be independently associated with sepsis in high-risk neonates(3). The current practice involves removal of the umbilical cathethers in presence of sepsis for fear of catheter colonization with persistent bacteremia. The benefits of such a practice however may be questionable given the similar infection rates when peripheral IV catheters were compared with UVCs in high-risk neonates(4). Recently UVCs bonded with rifampicin and amino-cycline were shown to prevent colonization with commoner catheter related organisms significantly for up to 14 days in an in vitro study(5). Pending confirmation of this observation by clinical studies, the option of leaving the UVC in situ while infusing appropriate antibiotics through them may obviate the need for multiple peripheral IV catheters while minimizing the associated pain and distress in high-risk neonates.

A. Shama,
S.K. Patole,
J.S. Whitehall,
Department of Neonatology,
Kirwan Hospital for Women,
Townsville, Queensland 4817, Australia.
E-mail: [email protected]

 

1. 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: 461-466.

 2. Bahandari V, Eisenfield I, Lerer T, Holman M, Rowe J. Nosocomial sepsis in neonates with single lumen vascular catheters. Indian Pediatr 1997; 64: 529-535.

 3. Moro ML, De Toni A, Stolfi I, Carrieri MP, Braga M, Zunin C. Risk factors for nosocomial sepsis in newborn intensive and intermediate care units. Eur J Pediatr 1996; 155: 315-322.

4. Parellada JA, Moise AA, Hegemier S, Gest AL. Percutaneous central catheters and peripheral intravenous catheters have similar infection rates in very low birth weight infants. J Perinatol 1999; 19: 251-254.

5. Norton RE, Patole S, Whitehall J. An in vitro study of the efficacy of rifampicin and minocycline coated umbilical venous catheters. Int J Antimicrobial Agents 2001; 17: 237- 240.