Initial vascular access for neonatal resuscitation: a systematic review

Area of Science:

• Neonatal Resuscitation
• Vascular Access
• Pediatric Critical Care

Background:

• Establishing vascular access in neonates during emergencies is challenging but vital for survival.
• Current evidence is insufficient to guide the optimal choice of vascular access methods.

Purpose of the Study:

• To evaluate evidence on emergency vascular access methods for neonatal resuscitation.
• Focus on infants up to 28 days or 44 weeks postmenstrual age.

Main Methods:

• Systematic literature search of multiple databases (Ovid Medline, Embase, Cochrane, CINAHL) up to February 2026.
• Included randomized controlled trials, non-RCTs, cohort studies, case series, and case reports.
• 16 articles (10 descriptive, 6 case reports) were analyzed from 1381 identified.

Main Results:

• No studies directly compared vascular access methods for key resuscitation outcomes.
• Intraosseous (IO) devices were associated with more reported complications.
• Umbilical vein catheters (UVC) primarily used post-hospital birth; IO devices used in diverse settings.
• Insufficient evidence for peripheral vein catheter use in neonatal resuscitation.

Conclusions:

• Very low certainty evidence suggests UVC and IO access are feasible in neonatal resuscitation.
• Lack of RCTs, small sample sizes, and heterogeneity from high-resource settings limit generalizability.
• Further research is crucial to assess effectiveness, timeliness, and safety of emergency vascular access methods.