Umbilical artery catheters in the newborn: effects of heparin

Abstract

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

Objectives: To determine whether the use of heparin in fluids infused through an umbilical arterial catheter in newborn infants influences the frequency of clinical ischemic events, catheter occlusion, aortic thrombosis, intraventricular hemorrhage, hypertension, death, or the duration of catheter usability.

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 heparinised to non heparinised infusion fluids, including comparison of heparin in the infusate to heparin just in the flush solution. Clinically important end points such as catheter occlusion or aortic thrombosis.

Data collection and analysis: There were five randomized controlled trials retrieved. All gave details of the incidence of catheter occlusion. Two also reported the incidence of aortic thrombosis. The intervention was reasonably consistent: heparin in the infusate at a concentration of 1 unit/mL was investigated in all trials except one which used a concentration of 0.25 units/mL. Studies generally included both term and preterm infants.

Main results: Heparinization of the infusate decreases the incidence of catheter occlusion but does not affect the frequency of aortic thrombosis. Heparinization of the flush solution is not an adequate alternative. There does not appear to be an effect on frequency of intraventricular hemorrhage, death or clinical ischemic phenomena.

Reviewer's conclusions: Heparinization of the fluid infused through an umbilical arterial catheter decreases the likelihood of umbilical arterial catheters occluding. The lowest concentration tested so far (0.25 units/mL) has been shown to be effective. Heparinization of flushes without heparinizing the infusate is ineffective. The frequency of aortic thrombosis has not been shown to be affected; however, the confidence intervals for this effect are very wide. The frequency of intraventricular hemorrhage has not been shown to be affected by heparinization of the infusate, but again the confidence intervals are very wide and even a major increase in the incidence of grade 3 and 4 intraventricular hemorrhage would not have been detected.

1.1. Analysis

Comparison 1 Heparin in infusate compared to no heparin, Outcome 1 Catheter occlusion prior to removal.

1.2. Analysis

Comparison 1 Heparin in infusate compared to no heparin, Outcome 2 Aortic thrombosis.

1.3. Analysis

Comparison 1 Heparin in infusate compared to no heparin, Outcome 3 Hypertension.

1.4. Analysis

Comparison 1 Heparin in infusate compared to no heparin, Outcome 4 Intraventricular hemorrhage, grade 3 and 4.

1.5. Analysis

Comparison 1 Heparin in infusate compared to no heparin, Outcome 5 Clinical ischemic phenomena.

1.6. Analysis

Comparison 1 Heparin in infusate compared to no heparin, Outcome 6 Death.