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Published on: December 31, 2015
Effects of Early versus Standard Central Line Removal on the Growth of Preterm Infants with Very Low Birth Weight: A
Justyna Romańska1, Tomasz Wawrzoniak2, Paweł Krajewski1
1Division of Neonatology and Neonatal Intensive Care, 1st Department of Obstetrics and Gynaecology, The Medical University of Warsaw, Starynkiewicza Sq. 1/3, 02-015 Warsaw, Poland.
Insights
Early central line (CL) removal in very preterm infants did not negatively impact short-term growth. This finding supports earlier discontinuation of CLs for very low birth weight (VLBW) infants receiving parenteral nutrition.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Clinical Trials
Background:
- Parenteral nutrition via central lines (CLs) is standard for very preterm infants.
- Optimal timing for CL discontinuation remains uncertain, impacting infant growth.
- Understanding CL removal timing is crucial for neonatal intensive care.
Purpose of the Study:
- To evaluate the effect of central line discontinuation timing on short-term growth in very preterm infants.
- To determine if early CL removal is non-inferior to standard practice for infant growth outcomes.
- To assess the safety and efficacy of modified CL removal protocols.
Main Methods:
- A non-inferiority, parallel-group randomized controlled trial.
- Involved very low birth weight (VLBW) preterm infants without congenital abnormalities.
- Compared CL discontinuation at 100 mL/kg/day (intervention) versus 140 mL/kg/day (control).
Main Results:
- Mean weight at 36 weeks' postmenstrual age was 2232 g (intervention) vs. 2200 g (control).
- The difference in weight (32 g) was not statistically significant and did not cross the non-inferiority margin.
- No adverse events related to the intervention were reported.
Conclusions:
- Early central line removal (at 100 mL/kg/day enteral feeding) is non-inferior to standard practice for short-term growth in VLBW infants.
- This suggests a potentially safer and more efficient approach to neonatal care.
- Supports evidence-based guidelines for optimizing central line management in preterm neonates.
Abstract:
Very preterm infants are usually supported by parenteral nutrition delivered through central lines (CLs) while progressing with enteral intake, although the optimal time point for their removal is unclear. This study evaluated the impact of the CL discontinuation time on the short-term growth outcomes of preterm infants. A non-inferiority, parallel-group, randomized controlled trial was conducted in four neonatal intensive care units in Poland. Preterm infants with very low birth weight (VLBW) without congenital abnormalities were eligible. Patients were allocated to discontinue central access at an enteral feeding volume of 100 mL/kg/day (intervention group) or 140 mL/kg/day (control group). The study's primary outcome was weight at 36 weeks' postmenstrual age, with a non-inferiority margin of -210 g. Overall, 211 patients were allocated to the intervention or control groups between January 2019 and February 2021, of which 101 and 100 were eligible for intention-to-treat analysis, respectively. The mean weight was 2232 g and 2200 g at 36 weeks' postmenstrual age in the intervention and control groups, respectively. The mean between-group difference was 32 g (95% confidence interval, -68 to 132; p = 0.531), which did not cross the specified margin of non-inferiority. No intervention-related adverse events were observed. Early CL removal was non-inferior to the standard type for short-term growth outcomes in VLBW infants.
