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. 2020;117(3):294-299.
doi: 10.1159/000506907. Epub 2020 Jun 19.

Neonatal Umbilical Arterial Catheter Removal Is Accompanied by a Marked Decline in Phlebotomy Blood Loss

Patrick D Carroll  1 , M Bridget Zimmerman  2 , Demet Nalbant  3 , Earl L Gingerich  3 , Guohua An  4 , Gretchen A Cress  3 , Peter Veng-Pedersen  4 , John A Widness  5
Affiliations

Neonatal Umbilical Arterial Catheter Removal Is Accompanied by a Marked Decline in Phlebotomy Blood Loss

Patrick D Carroll et al. Neonatology. 2020.

Abstract

Background: Umbilical arterial catheters (UACs) are frequently used in critically ill neonates. UAC are convenient, reliable, and allow for caregiver convenience in performing painless arterial blood sampling. We hypothesized that UAC removal in extremely low birth weight (ELBW) neonates will result in significantly less phlebotomy blood loss (PBL) after correcting for severity of illness.

Study design and methods: PBL was measured at a single center in 99 ELBW infants who survived to day 28. Individual infant's paired daily PBL for the two 24-h periods before and after UAC removal were compared using the paired t test. Daily PBL up to 7 days before and 7 days after UAC removal were compared using a logistic regression with mixed model analysis for repeated measures. Cumulative 28-day phlebotomy loss was evaluated by multiple linear regression analysis.

Results: PBL 24 h before and after UAC removal were 1.7 mL (95% CI 1.5-1.9) and 0.9 mL (95% CI 0.8-1.0; p < 0.0001), respectively. Cumulative 28-day PBL increased by 2.2 mL (±0.7) per day that a UAC was present with or without correction for severity of illness (p < 0.001).

Conclusion: UAC removal is independently associated with a marked decline in PBL. We speculate the ease and convenience of UAC blood sampling lead to more frequent blood testing and greater PBL.

Keywords: Anemia of prematurity; Phlebotomy blood loss; Umbilical arterial catheter.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Daily PBL is higher among subjects with a UAC present for each of the first 28 d.
Figure 2.
Figure 2.
Cumulative 28 d PBL is higher among subjects with a UAC present. (p<0.001).
Figure 3.
Figure 3.
Abrupt decrease in PBL after UAC removal. A gradual significant decline in PBL was observed until UAC removal occurred (p=0.0001). After UAC removal there was an abrupt decrease in PBL (p<0.001) from the UAC to the no-UAC period followed by a stable rate of change in daily PBL (p=0.26).
Figure 4.
Figure 4.
The interaction of SNAP score at birth and the UAC days are indicated by different SNAP scores having different 28 d PBL. Modeled UAC days increased the predicted PBL by 6.9 mL for each day a UAC was present when the SNAP score was <20 at birth. PBL increased by 3.9 mL for each day a UAC was present when the SNAP score was ≥30 at birth. However, when the SNAP score at birth was 20–29 the predicted 28 d PBL only increased by 1.2 mL.
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