Predicting Risk of Adverse Events in Neonates with Umbilical Vascular Catheters

Umbilical vascular catheters (UVCs and UACs) are vital in neonatal intensive care, providing access for fluid, nutrition, and medication delivery. However, these catheters are also associated with a range of adverse events (AEs), including infection, thrombosis, and dislodgement. A recent study aimed to develop a clinical risk prediction model to better identify neonates at higher risk of complications from these catheters.

Study Overview
Using retrospective data from a South Australian NICU (2015-2017), the study analyzed 245 UVCs and 249 UACs in 236 infants. Researchers applied LASSO regression to build a risk model based on various clinical factors, with a focus on predicting "any AE" across a wide range of catheter-related complications.

Key Findings

• 71% of UVCs and 43.8% of UACs were associated with at least one adverse event.
• No predictors were identified for UVC-related AEs, suggesting current dwell-time-based decisions may be overly cautious.
• For UACs, five predictors were identified:

1. Thrombocytopaenia
2. Intrauterine growth restriction (IUGR)/Small for gestational age (SGA)
3. Congenital heart disease (CHD)
4. Maternal diabetes
5. Dwell time >7 days

• The model showed good calibration and modest discrimination (AUROC 0.68).

Clinical Implications
? Use of this risk model may support more tailored decisions regarding catheter use and removal.
? Findings challenge the blanket practice of removing UVCs based solely on dwell time.
? Highlighted the need for better insertion techniques, use of POCUS, and securement methods, particularly for high-risk neonates.

Conclusion
This study presents the first validated risk prediction model for UAC-related adverse events. While external validation is needed, it marks a promising step toward personalized catheter care in the NICU, enhancing both safety and decision-making.

Read more:https://www.australiancriticalcare.com/article/S1036-7314(24)00297-2/fulltext 

Authors: Kim Gibson, Amber Smith, Rebecca Sharp, Amanda Ullman, Scott Morris, Adrian Esterman