[Invasive catheters in neonates].
OBJECTIVE
The care of very sick babies requires the use of invasive catheters in the neonatal intensive care unit. Our objective was to review the invasive catheters placed (umbilical and epicutaneous) between 1994 and 1998 and describe the guidelines used to take care of the intravenous lines.


METHODS
Two periods were compared (January 1994 until June 1997 and July 1997 until September 1998) and characteristics of the patient and catheter were analyzed. During the first period, sepsis related to the catheter was diagnosed according to clinical and analytical criteria and required a positive blood culture. The same criteria were required in the second period, but coincidence of the organisms in the peripheral and catheter blood culture was also needed.


RESULTS
A total of 1,285 central catheters were studied in 958 newborn admissions. Umbilical catheter were used in 6% of the cases and epicutaneous in 23%, most of which were in the upper extremities. The most frequent reason to remove the catheter was the end of the indication. The incidence of catheter related sepsis in the first period was 1% and during the second period 6%. Strict diagnostic criteria used in the second period were more predictive for sepsis. If premature babies were considered alone, the incidence increased to 14%. The most frequent organism isolated was Staphylococcus epidermidis.


CONCLUSIONS
To decrease the incidence of sepsis related to catheters, a strict protocol for placement and maintenance must be followed.
Sánchez García-Vao
C
C
Servicio Neonatología, Universitat de Barcelona.
Carbonell Estrany
X
X
Esqué Ruiz
M T
MT
Barjau Capdevila
M
M
Mingueza Ortega
J
J
Giraldó Lozano
L
L
D002391:Catchment Area, Health; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000382:microbiology*; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000209:etiology*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification*