Central line-associated bloodstream infection related with umbilical vein catheterization and peripherally inserted central catheter in preterm infants: a meta-analysis and systematic review

  • Indra Sandinirwan Department of Pediatrics, Hermina Sukabumi Hospital, Sukabumi, Indonesia https://orcid.org/0000-0001-6421-5789
  • Henry Leo Department of Pediatrics, Bintuni Public Hospital, West Papua, Indonesia
  • Bani Muslim Indonesian Medical Association, Bandung, Indonesia
  • Hasanah Indonesian Medical Association, Sukabumi, Indonesia
  • Permata Putri Karina School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Keywords: bloodstream infection, peripherally inserted central catheter, umbilical veins


BACKGROUND Central line-associated bloodstream infection (CLABSI) is a serious complication in preterm infants undergoing catheterization, including umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) placement. This study aimed to compare the occurrence rate of CLABSI in preterm infants associated with UVC and PICC.

METHODS We conducted a systematic review and meta-analysis of studies published from 2000 to 2023 using a random effects model from 3 databases (PubMed, ScienceDirect, and Google Scholar). This study was registered with PROSPERO (CRD42023416471).

RESULTS Of 10 articles included in the systematic review, 2 were randomized controlled trials, 3 were prospective studies, and the rest were retrospective. A total of 3,962 UVCs and 2,922 PICCs were incorporated in the meta-analysis. The incidence rate of CLABSI in the UVC group was lower than that in the PICC group (1.23 versus 3.03 per 1,000 catheter days). However, the odds of developing CLABSI for infants with a UVC compared to those with a PICC were not statistically significant (odds ratio: 0.88, 95% confidence interval: 0.54–1.42).

CONCLUSIONS UVCs had a lower incidence rate of CLABSI than PICCs. Therefore, additional prospective studies are required to confirm these results.


Hess S, Poryo M, Böttger R, Franz A, Klotz D, Linnemann K, et al. Umbilical venous catheter- and peripherally inserted central catheter-associated complications in preterm infants with birth weight < 1250 g : results from a survey in Austria and Germany. Wien Med Wochenschr. 2023;173(7-8):161-7. https://doi.org/10.1007/s10354-022-00952-z

Yeung CY. Complications of umbilical venous catheters in neonates: a safety reappraisal. Pediatr Neonatol. 2020;61(1):1-2. https://doi.org/10.1016/j.pedneo.2013.09.011

Goh SS, Kan SY, Bharadwaj S, Poon WB. A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore. Singapore Med J. 2021;62(1):29-33. https://doi.org/10.11622/smedj.2019140

Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(6):724-34. https://doi.org/10.1016/S1473-3099(15)00409-0

Payne V, Hall M, Prieto J, Johnson M. Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2018;103(5):F422-9. https://doi.org/10.1136/archdischild-2017-313362

Gibson K, Sharp R, Ullman A, Morris S, Kleidon T, Esterman A. Adverse events associated with umbilical catheters: a systematic review and meta-analysis. J Perinatol. 2021;41(10):2505-12. https://doi.org/10.1038/s41372-021-01147-x

Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg RP, et al. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PLoS One. 2020;15(1):e0227772. https://doi.org/10.1371/journal.pone.0227772

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339(7716):332-6. https://doi.org/10.1136/bmj.b2535

Butler-O'Hara M, D'Angio CT, Hoey H, Stevens TP. An evidence-based catheter bundle alters central venous catheter strategy in newborn infants. J Pediatr. 2012;160(6):972-7.e2. https://doi.org/10.1016/j.jpeds.2011.12.004

Centers for Disease Control and Prevention. Background information: terminology & estimates of risk [Internet]. Centers for Disease Control and Prevention; 2015 [updated 2015 Nov 5; cited 2023 Jun 6]. Available from: https://www.cdc.gov/infectioncontrol/guidelines/bsi/background/terminology.html.

Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1):245. https://doi.org/10.1186/s13643-017-0644-y

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):1-10. https://doi.org/10.1186/s13643-016-0384-4

Lin L, Xu C. Arcsine-based transformations for meta-analysis of proportions: pros, cons, and alternatives. Health Sci Rep. 2020;3(3):e178. https://doi.org/10.1002/hsr2.178

Doi SA, Xu C. The Freeman-Tukey double arcsine transformation for the meta-analysis of proportions: recent criticisms were seriously misleading. J Evid Based Med. 2021;14(4):259-61. https://doi.org/10.1111/jebm.12445

Barendregt JJ, Doi SA. MetaXL user guide. Queensland: EpiGear International Pty Ltd.; 2016.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for systematic reviews of interventions. 2nd ed. Chichester: John Wiley & Sons; 2019. https://doi.org/10.1002/9781119536604

Furuya-Kanamori L, Barendregt JJ, Doi SA. A new improved graphical and quantitative method for detecting bias in meta-analysis. Int J Evid Based Healthc. 2018;16(4):195-203. https://doi.org/10.1097/XEB.0000000000000141

Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007;18(6):805-35. https://doi.org/10.1097/EDE.0b013e3181577511

Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. https://doi.org/10.1136/bmj.c332

Butler-O'Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D'Angio CT. A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics. 2006;118(1):e25-35. https://doi.org/10.1542/peds.2005-1880

Dongara AR, Patel DV, Nimbalkar SM, Potana N, Nimbalkar AS. Umbilical venous catheter versus peripherally inserted central catheter in neonates: a randomized controlled trial. J Trop Pediatr. 2017;63(5):374-9. https://doi.org/10.1093/tropej/fmw099

Konstantinidi A, Sokou R, Panagiotounakou P, Lampridou M, Parastatidou S, Tsantila K, et al. Umbilical venous catheters and peripherally inserted central catheters: are they equally safe in vlbw infants? a non-randomized single center study. Medicina (Kaunas). 2019;55(8):442. https://doi.org/10.3390/medicina55080442

Hei MY, Zhang XC, Gao XY, Zhao LL, Wu ZX, Tian L, et al. Catheter-related infection and pathogens of umbilical venous catheterization in a neonatal intensive care unit in China. Am J Perinatol. 2012;29(2):107-14. https://doi.org/10.1055/s-0031-1295650

Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol. 2011;32(1):42-9. https://doi.org/10.1086/657634

Arnts IJ, Bullens LM, Groenewoud JM, Liem KD. Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns. J Obstet Gynecol Neonatal Nurs. 2014;43(2):205-15. https://doi.org/10.1111/1552-6909.12278

Shalabi M, Adel M, Yoon E, Aziz K, Lee S, Shah PS, et al. Risk of infection using peripherally inserted central and umbilical catheters in preterm neonates. Pediatrics. 2015;136(6):1073-9. https://doi.org/10.1542/peds.2015-2710

Yumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr. 2013;102(7):e293-8. https://doi.org/10.1111/apa.12256

Sanderson E, Yeo KT, Wang AY, Callander I, Bajuk B, Bolisetty S, et al. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect. 2017;97(3):267-74. https://doi.org/10.1016/j.jhin.2017.06.023

Nielsen CL, Zachariassen G, Holm KG. Central line-associated bloodstream infection in infants admitted to a level lllneonatal intensive care unit. Dan Med J. 2022;69(5):A05210463.

Hallam C, Jackson T, Rajgopal A, Russell B. Establishing catheter-related bloodstream infection surveillance to drive improvement. J Infect Prev. 2018;19(4):160-6. https://doi.org/10.1177/1757177418767759

Haddadin Y, Annamaraju P, Regunath H. Central line-associated blood stream infections. [updated 2022 Nov 26]. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430891/.

Cho HJ, Cho HK. Central line-associated bloodstream infections in neonates. Korean J Pediatr. 2019;62(3):79-84. https://doi.org/10.3345/kjp.2018.07003

Basha S, Surendran N, Pichichero M. Immune responses in neon ates. Expert Rev Clin Immunol. 2014;10(9):1171-84. https://doi.org/10.1586/1744666X.2014.942288

Tsafaras GP, Ntontsi P, Xanthou G. Advantages and limitations of the neonatal immune system. Front Pediatr. 2020;8:5. https://doi.org/10.3389/fped.2020.00005

Dos Anjos Borges LG, Pastuschek J, Heimann Y, Dawczynski K, Bergner M, Haase R, et al. Vaginal and neonatal microbiota in pregnant women with preterm premature rupture of membranes and consecutive early onset neonatal sepsis. BMC Med. 2023;21(1):92. https://doi.org/10.1186/s12916-023-02805-x

Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013;132(6):e1609-15. https://doi.org/10.1542/peds.2013-1645

How to Cite
Sandinirwan I, Leo H, Muslim B, Hasanah, Karina PP. Central line-associated bloodstream infection related with umbilical vein catheterization and peripherally inserted central catheter in preterm infants: a meta-analysis and systematic review. Med J Indones [Internet]. 2023Dec.29 [cited 2024Feb.21];1(1). Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/7071
Clinical Research