A randomised, controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial.
BACKGROUND
Infections are common complications of neonatal long lines. Heparin has been shown to prolong the effective duration of neonatal long lines and to reduce the ability of bacteria to adhere to foreign surfaces, but the effect of heparin on rates of infection is uncertain.


OBJECTIVE
The goal of this study was to evaluate the effect of heparin on the frequency of episodes of catheter-related sepsis (CRS) in infants receiving total parenteral nutrition (TPN) through a neonatal long line.


METHODS
This randomised, controlled, double blind, single-centre clinical trial compared heparin at 0.5 IU/ml with no heparin in TPN infused through a neonatal long line, with episodes of CRS as the primary outcome.


RESULTS
210 infants were enrolled (TPN with heparin n=102, TPN without heparin n=108). There was a statistically significant reduction in all episodes of culture-positive CRS in those infants with heparin added to the TPN compared with those without heparin (p=0.04; RR 0.57, 95% CI 0.32 to 0.98; number needed to treat 9, 95% CI 4.6 to 212.4).


CONCLUSIONS
The addition of heparin at 0.5 IU/ml to TPN infused through a neonatal long line reduces the incidence of culture-positive CRS.
Newborn Services, Auckland District Health Board, Auckland, New Zealand. pitabirch@gmail.com
Pita
P
Birch
Simon
S
Ogden
Michael
M
Hewson
D000925:Anticoagulants / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control; D001724:Birth Weight; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000382:microbiology; D004812:Epidemiologic Methods; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000295:instrumentation*; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin