Initial vascular access for neonatal resuscitation: a systematic review

Area of Science:

• Neonatal Resuscitation
• Vascular Access
• Pediatric Critical Care

Background:

• Establishing vascular access during neonatal resuscitation or cardiac arrest is critical but challenging.
• Evidence supporting the optimal choice of vascular access methods is limited.
• Newborn infants up to 28 days or 44 weeks postmenstrual age are the focus.

Purpose of the Study:

• To summarize and evaluate evidence on emergency vascular access methods in newborn infants.
• Assess feasibility, timeliness, and safety of different access methods.

Main Methods:

• Searched Ovid Medline, Embase, Cochrane, and CINAHL databases.
• Included RCTs, non-RCTs, cohort studies, case series, and case reports.
• 16 articles (10 descriptive, 6 case reports) were included from 1381 identified.

Main Results:

• No studies directly compared vascular access methods for key outcomes like time to heart rate normalization or successful placement.
• Intraosseous (IO) devices were associated with more reported complications.
• Umbilical vein catheters (UVC) were primarily used post-hospital birth; IO devices were used in diverse settings.
• Evidence on peripheral vein catheters was insufficient.

Conclusions:

• Very low certainty evidence suggests emergency UVC and IO access are feasible in neonatal resuscitation.
• Limited evidence on effectiveness, timeliness, and safety necessitates further research.
• Lack of RCTs, small sample sizes, and heterogeneity from high-resource settings limit generalizability.